Testing Patterns and Disparities for Alpha-1 Antitrypsin Deficiency

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Alpha-1 antitrypsin deficiency is an under-recognized, genetic cause of chronic lung and liver disease, and it remains unclear what the testing frequency and disparities are for alpha-1 antitrypsin deficiency. This is a retrospective cohort study of people with newly diagnosed chronic obstructive pulmonary disease and liver disease identified at the University of Florida between January 1, 2012 and December 31, 2021. We performed incidence and prevalence analysis for alpha-1 antitrypsin (AAT) testing and point-biserial correlation analysis for tobacco use and AAT testing. We evaluated characteristics with AAT testing using adjusted multivariable logistic regression. Among 75,810 subjects with newly diagnosed chronic obstructive pulmonary disease and liver disease between 2012 and 2021, 4,248 (5.6%) were tested for alpha-1 antitrypsin deficiency. All subjects had an AAT level performed, while 1,654 (39%) had phenotype testing. Annual incidence of testing increased for subjects with newly diagnosed chronic obstructive pulmonary disease or liver disease from 2.8% and 5.4% in 2012 to 4.1% and 11.3% in 2021 respectively. Adjusted multivariable regression analysis showed factors favoring AAT testing were White race, and concomitant chronic obstructive pulmonary disease and liver disease. Increasing age, non-White race, current tobacco use, and being a male with chronic obstructive pulmonary disease had lower odds of AAT testing. Although slowly improving, testing for alpha-1 antitrypsin deficiency continues to have a low uptake in the clinical setting despite guidelines recommending broader testing. Persons of White race and those with concomitant chronic obstructive pulmonary disease and liver disease are more likely to be tested, while older subjects, persons of non-White race, current tobacco use, and men with chronic obstructive pulmonary disease are less favored to be tested.