Individuals in the highest socioeconomic class were also more likely to die above the median age of death than those in the lowest socioeconomic class (from 1959 to 2000, adjusted odds ratio for sex 2.50, 2.16 to 2.90; from 2001 to 2008, 1.89, 1.20 to 2.97).Conclusions Socioeconomic status and sex remain strong determinants of survival from cystic fibrosis in England and Wales, and the magnitude of these effects does not appear to have substantially reduced over time.IntroductionOver the past 50 years, survival in individuals with cystic fibrosis has improved greatly, with the median age at death rising from 6 months in 19591 to 27 years in 2008.2 For individuals with cystic fibrosis born in 2000, the median age of survival is predicted to approach 50 years.3 4 5 Improved survival has been attributed to multiple factors including early diagnosis,6 7 improvements in nutrition,8 infection control,9 10 11 nebulised mucolytics,12 and antibiotic treatment.13 14 Factors associated with early death include the F508 mutation,15 pancreatic insufficiency,16 17 low body mass index,18 early acquisition of Pseudomonas aeruginosa pandora earrings,19 20 21 low socioeconomic status,1 22 23 and female sex.24 25 26 27High socioeconomic status was identified as a marker of good prognosis in cystic fibrosis over 20 years ago, when children with cystic fibrosis from manual socioeconomic groups in England and Wales were found to be nearly three times more likely to die below the annual median age at death than those from non manual socioeconomic groups.1 Schechter and colleagues reported a similar effect in Medicaid patients in the United States,22 and other reports have shown reduced survival in patients living in postal code areas with below median incomes.23The association between female sex and impaired prognosis in cystic fibrosis has also been well described,24 25 with a median difference of 3.1 years in one study.26 A Canadian study reported that females had more than twice the two year risk of death than their male counterparts.27 Other studies have reported poorer survival in females than in males in the United States24 and the United Kingdom.28The past 20 years have seen considerable improvements in healthcare provision, including improvements in antibiotic and nutrition treatment, and the use of multidisciplinary approaches to management with the formation of specialist treatment centres. We postulated that improvements in healthcare provision will weaken the effect of socioeconomic status and sex on median age at death from cystic fibrosis.MethodsWe obtained mortality data for cystic fibrosis for England and Wales for 1959 to 2008 from the Office for National Statistics. We used the International Classification of Diseases (ICD) applying to cystic fibrosis to code cause of death.

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