Creel, Michael Eric
(2008)
Gender Differences in Survival in Idiopathic Pulmonary Fibrosis and Following Lung Transplant.
Master's Thesis, University of Pittsburgh.
(Unpublished)
Abstract
Idiopathic Pulmonary Fibrosis (IPF) is a chronic and progressive form of interstitial lung disease characterized by inflammation and abnormal tissue repair ultimately leading to decreased pulmonary function and death. Risk factors for IPF are largely unknown and medical treatment offers a poor prognosis due to the lack of effective treatment options. Survival outcomes were analyzed for a cohort of 331 patients. The median age at clinical evaluation for IPF was 69 years. Subjects survived an average of 21.82 months after diagnosis, with a higher survival in females than in males. Males had a risk 2.85 times higher than females of death. Subjects older than 69 years of age had a relative risk of dying of 1.6 in comparison to subjects younger than 69 years. Predictors of survival after lung transplant were also analyzed in a cohort of 990 lung transplanted patients. The overall survival was 41.6%, (41.5 % in males, and 41.8 % in females), the average length of the follow up was 45.84 plus or minus 51.98 months (range 0 to 282.47 months). Females tend to live longer than males: 50.75 plus or minus 55.41 months versus 40.64 plus or minus 47.60 months, respectively. Males had a risk of dying during the follow up that was 1.18 (95% CI 1.01-1.40) relative to females, after adjusting for ethnicity, age, smoking status, diagnosis and donor characteristics. Females who had at least one full term pregnancy during their life had better survival rates than females who had no full term pregnancies.Our results of a better survival after lung transplant in females (particularly females with at least one pregnancy) support the hypothesis of a hormonal contribution to survival and of the development of immunotolerance after pregnancy.The public health significance includes the use of the current study as a model in understanding the role of immunity in cancer development. The age-adjusted incidence rate is 555.8 per 100,000 men and 411.3 per 100,000 women per year (2000-2004), and the combined lifetime risk of cancer is approximately 1 in 2. Thus, any further understanding of cancer causes would be worthwhile in cancer prevention and treatment efforts.
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Details
| Item Type: |
University of Pittsburgh ETD
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| Status: |
Unpublished |
| Creators/Authors: |
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| ETD Committee: |
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| Date: |
30 January 2008 |
| Date Type: |
Completion |
| Defense Date: |
7 November 2007 |
| Approval Date: |
30 January 2008 |
| Submission Date: |
12 November 2007 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Occupational Medicine |
| Degree: |
MPH - Master of Public Health |
| Thesis Type: |
Master's Thesis |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
gender; immunology; pregnancy; fetal antigens; interstitial lung disease |
| Other ID: |
http://etd.library.pitt.edu/ETD/available/etd-11122007-142259/, etd-11122007-142259 |
| Date Deposited: |
10 Nov 2011 20:04 |
| Last Modified: |
15 Nov 2016 13:51 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/9641 |
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