Mapping IPF helps identify geographic regions at higher risk for disease development and potential triggers

Abstract

Background and objective The relationship between IPF development and environmental factors has not been completely elucidated. Analysing geographic regions of idiopathic pulmonary fibrosis (IPF) cases could help identify those areas with higher aggregation and investigate potential triggers. We hypothesize that cross‐analysing location of IPF cases and areas of consistently high air pollution concentration could lead to recognition of environmental risk factors for IPF development. Methods This retrospective study analysed epidemiological and clinical data from 503 patients registered in the Observatory IPF.cat from January 2017 to June 2019. Incident and prevalent IPF cases from the Catalan region of Spain were graphed based on their postal address. We generated maps of the most relevant air pollutant PM2.5 from the last 10 years using data from the CALIOPE air quality forecast system and observational data. Results In 2018, the prevalence of IPF differed across provinces; from 8.1 cases per 100 000 habitants in Barcelona to 2.0 cases per 100 000 in Girona. The ratio of IPF was higher in some areas. Mapping PM2.5 levels illustrated that certain areas with more industry, traffic and shipping maintained markedly higher PM2.5 concentrations. Most of these locations correlated with higher aggregation of IPF cases. Compared with other risk factors, PM2.5 exposure was the most frequent. Conclusion In this retrospective study, prevalence of IPF is higher in areas of elevated PM2.5 concentration. Prospective studies with targeted pollution mapping need to be done in specific geographies to compile a broader profile of environmental factors involved in the development of pulmonary fibrosis.

Air Pollution—An Overlooked Risk Factor for Idiopathic Pulmonary Fibrosis

“…It is well known that NO 2 is a surrogate of traffic-related exposure [ 68 ]; therefore, the study results provide a strong signal that traffic pollution could be involved in the initiation of the fibrotic process and identify a potentially modifiable risk factor for IPF [ 67 ]. A recent retrospective study aimed to identify environmental risk factors for IPF development [ 69 ]. Using the cross-analysis of the incident cases of the disease in the Catalan region, Spain, and estimated exposure to PM 2.5 over the last decade, authors found a coincidence between IPF patient aggregation and PM 2.5 concentration.…”

Mapping air pollution and idiopathic pulmonary fibrosis

“…The relevant occupational exposures for IPF can be described in more detail than ‘inorganic dust’ 5 . We have recently conducted a case–control study of IPF in Australia to examine occupational and environmental risk factors, 7 utilizing job exposure matrices to assess occupational exposures.…”

“…The Catalonian study 5 did not age‐adjust the data for this disease, although IPF occurs predominantly in the more elderly. Nor did the authors take into account the illustrated sharp seasonal peaks of PM 2.5 , which might well have been influenced by marked increases in winds off the Mediterranean Sea at these times.…”

“…In a recent publication in Respirology, Shull et al report that mapping IPF helps to identify geographic regions at higher risk of IPF prevalence. 5 The authors recruited 503 patients from the Catalonian IPF registry, but only 75% could be included in the analysis because of missing data. PM 2.5 was estimated by a highly spatially and temporally resolved model that included emissions, meteorology, chemical transport and mineral dust models.…”

“…The relevant occupational exposures for IPF can be described in more detail than 'inorganic dust'. 5 We have recently conducted a case-control study of IPF in Australia to examine occupational and environmental risk factors, 7 utilizing job exposure matrices to assess occupational exposures. We found that an increased risk of IPF was associated with occupational exposures to second-hand smoke, respirable dust and asbestos, but not with other specific organic, mineral or metal dusts.…”