The Cystic Fibrosis Survival Gap: Why Do Canadians Fare Better Than Americans?
Authors: Patrick A. Flume, Donald R. VanDevanter
Journal: Annals of Internal Medicine (2017)

Editorials18 April 2017The Cystic Fibrosis Survival Gap: Why Do Canadians Fare Better Than Americans?Patrick A. Flume, MD and Donald R. VanDevanter, PhDPatrick A. Flume, MDFrom Medical University of South Carolina, Charleston, South Carolina, and Case Western Reserve University School of Medicine, Cleveland, Ohio.Search for more papers by this author and Donald R. VanDevanter, PhDFrom Medical University of South Carolina, Charleston, South Carolina, and Case Western Reserve University School of Medicine, Cleveland, Ohio.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-0564 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Cystic Fibrosis Foundation Patient Registry (CFFPR) has chronicled considerable improvement during recent decades in the median predicted survival of U.S. patients with cystic fibrosis (1). Increased survival has been attributed to better nutrition, particularly in infants and young children; the approval and use of new medications for cystic fibrosis complications; and continual improvement in quality of care, a powerful tool made possible by CFFPR data transparency. Comparisons of outcomes among U.S. care centers have been a driving force in recognizing and adopting best-care practices (2).In recent years, the strategy of comparing outcomes in different settings to recognize improvement ...References1. MacKenzie T, Gifford AH, Sabadosa KA, Quinton HB, Knapp EA, Goss CH, et al. Longevity of patients with cystic fibrosis in 2000 to 2010 and beyond: survival analysis of the Cystic Fibrosis Foundation patient registry. Ann Intern Med. 2014;161:233-41. [PMID: 25133359]. doi:10.7326/M13-0636 LinkGoogle Scholar2. Schechter MS. Benchmarking to improve the quality of cystic fibrosis care. Curr Opin Pulm Med. 2012;18:596-601. [PMID: 22965277] doi:10.1097/MCP.0b013e328358d5333 CrossrefMedlineGoogle Scholar3. Goss CH, MacNeill SJ, Quinton HB, Marshall BC, Elbert A, Knapp EA, et al. Children and young adults with CF in the USA have better lung function compared with the UK. Thorax. 2015;70:229-36. [PMID: 25256255] doi:10.1136/thoraxjnl-2014-205718 CrossrefMedlineGoogle Scholar4. Stephenson AL, Sykes J, Stanojevic S, Quon BS, Marshall BC, Petren K, et al. Survival comparison of patients with cystic fibrosis in Canada and the United States: a population-based cohort study. Ann Intern Med. 2017;166:537-46. doi:10.7326/M16-0858 LinkGoogle Scholar5. Vock DM, Durheim MT, Tsuang WM, Copeland CA, Tsiatis AA, Davidian M, et al. Survival benefit of lung transplantation in the modern era of lung allocation. Ann Am Thorac Soc. 2017;14:172-181. [PMID: 27779905] doi:10.1513/AnnalsATS.201606-507OC CrossrefMedlineGoogle Scholar6. Stephenson AL, Sykes J, Berthiaume Y, Singer LG, Aaron SD, Whitmore GA, et al. Clinical and demographic factors associated with post-lung transplantation survival in individuals with cystic fibrosis. J Heart Lung Transplant. 2015;34:1139-45. [PMID: 26087666] doi:10.1016/j.healun.2015.05.003 CrossrefMedlineGoogle Scholar7. Merlo CA, Clark SC, Arnaoutakis GJ, Yonan N, Thomas D, Simon A, et al. National healthcare delivery systems influence lung transplant outcomes for cystic fibrosis. Am J Transplant. 2015;15:1948-57. [PMID: 25809545] doi:10.1111/ajt.13226 CrossrefMedlineGoogle Scholar8. Corey M, McLaughlin FJ, Williams M, Levison H. A comparison of survival, growth, and pulmonary function in patients with cystic fibrosis in Boston and Toronto. J Clin Epidemiol. 1988;41:583-91. [PMID: 3260274] CrossrefMedlineGoogle Scholar9. Schechter MS, Shelton BJ, Margolis PA, Fitzsimmons SC. The association of socioeconomic status with outcomes in cystic fibrosis patients in the United States. Am J Respir Crit Care Med. 2001;163:1331-7. [PMID: 11371397] CrossrefMedlineGoogle Scholar10. Siddiqi A, Kawachi I, Keating DP, Hertzman C. A comparative study of population health in the United States and Canada during the neoliberal era, 1980-2008. Int J Health Serv. 2013;43:193-216. [PMID: 23821902] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Medical University of South Carolina, Charleston, South Carolina, and Case Western Reserve University School of Medicine, Cleveland, Ohio.Disclosures: Dr. Flume reports grants and personal fees from the Cystic Fibrosis Foundation outside the submitted work. Dr. VanDevanter reports personal fees from the Cystic Fibrosis Foundation outside the submitted work. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0564.Corresponding Author: Patrick A. Flume, MD, Medical University of South Carolina, 96 Jonathan Lucas Street, Room 816-CSB MSC 630, Charleston, SC 29425; e-mail, [email protected]edu.Current Author Addresses: Dr. Flume: Medical University of South Carolina, 96 Jonathan Lucas Street, Room 816-CSB MSC 630, Charleston, SC 29425.Dr. VanDevanter: Case Western Reserve University School of Medicine, 12520 33rd Street Court East, Edgewood, WA 98372.This article was published at Annals.org on 14 March 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSurvival Comparison of Patients With Cystic Fibrosis in Canada and the United States Anne L. Stephenson , Jenna Sykes , Sanja Stanojevic , Bradley S. Quon , Bruce C. Marshall , Kristofer Petren , Josh Ostrenga , Aliza K. Fink , Alexander Elbert , and Christopher H. Goss Metrics Cited bySurvival estimates in European cystic fibrosis patients and the impact of socioeconomic factors: a retrospective registry cohort study 18 April 2017Volume 166, Issue 8Page: 599-600KeywordsChildrenCystic fibrosisDisclosureHealth careHealth insuranceLung transplantationNutritionPopulation statisticsTransplantationYoung adults ePublished: 14 March 2017 Issue Published: 18 April 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...