{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:14:57Z","timestamp":1790709297432,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Cystic fibrosis has been transformed by the development of CFTR modulator therapies, with substantial improvements in survival and quality of life. However, access to these therapies remains profoundly unequal worldwide. The greatest benefits have been realized in high\u2010income countries, while people with cystic fibrosis in low\u2010 and middle\u2010income countries and underserved populations within high\u2010income settings continue to face limited access and poorer outcomes. Underdiagnosis is a major contributor to these disparities, as limited newborn screening, restricted access to sweat testing, and incomplete genetic characterization directly limit treatment eligibility and registry inclusion. Beyond diagnosis, disparities are driven by differences in genetic variant distribution, pricing and reimbursement policies, regulatory processes, and health system capacity. This review examines how these interrelated factors shape global access to therapies, with particular emphasis on CFTR modulators. Emerging strategies\u2014including differential pricing, licensing mechanisms, regulatory adaptation, international collaboration, and health system strengthening\u2014are discussed. Achieving equitable access will require coordinated action across diagnostic, economic, and policy domains to ensure that advances in cystic fibrosis care benefit patients regardless of geographic or socioeconomic context.<\/jats:p>","DOI":"10.1002\/ppul.71560","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T08:20:18Z","timestamp":1773044418000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Disparities in Access to Cystic Fibrosis Therapy Across Countries"],"prefix":"10.1002","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0605-8871","authenticated-orcid":false,"given":"Bulent","family":"Karadag","sequence":"first","affiliation":[{"name":"Marmara University, Division of Pediatric Pulmonology Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"e_1_2_18_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(19)30337-6"},{"issue":"1","key":"e_1_2_18_3_1","first-page":"S90","article-title":"Expanding the Impact of New Cystic Fibrosis Therapies in Low\u2010 and Middle\u2010Income Countries","volume":"60","author":"Kerem E.","year":"2025","journal-title":"Pediatric Pulmonology"},{"key":"e_1_2_18_4_1","unstructured":"Cystic Fibrosis Foundation \u201cCystic Fibrosis Foundation Patient Registry: 2023 Annual Data Report \u201d Accessed September 5 2025 https:\/\/www.cff.org\/medical-professionals\/patient-registry."},{"key":"e_1_2_18_5_1","unstructured":"A.Zolin A.Adamoli E.Bakkeheim et al. \u201cEuropean Cystic Fibrosis Society Patient Registry: Annual Report 2023 \u201d ECFS; 2025. Accessed September 8 2025 https:\/\/www.ecfs.eu\/projects\/ecfs-patient-registry\/annual-reports."},{"key":"e_1_2_18_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.26954"},{"key":"e_1_2_18_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccm.2023.03.011"},{"key":"e_1_2_18_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2022.03.006"},{"key":"e_1_2_18_9_1","unstructured":"World Health Organization \u201cWorld Report on Social Determinants of Health Equity \u201d Geneva: World Health Organization; 2025. Licence: CC BY\u2010NC\u2010SA 3.0 IGO."},{"key":"e_1_2_18_10_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.02288-2020"},{"key":"e_1_2_18_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prrv.2020.07.004"},{"key":"e_1_2_18_12_1","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00856-2020"},{"key":"e_1_2_18_13_1","unstructured":"Anadolu Agency \u201cReimbursement of CFTR Modulators in Turkey \u201d 2024 Accessed September 8 2025 https:\/\/www.aa.com.tr\/tr\/saglik\/kanserin-yani-sira-kistik-fibrozis-hastalarinin-ilaclari-da-geri-odeme-kapsamina-alinacak-\/3618693."},{"key":"e_1_2_18_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2025.02.010"},{"key":"e_1_2_18_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13161996"},{"key":"e_1_2_18_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gim.2022.06.009"},{"key":"e_1_2_18_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13023-024-03522-1"},{"key":"e_1_2_18_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.26939"},{"key":"e_1_2_18_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lansea.2024.100434"},{"key":"e_1_2_18_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.71194"},{"key":"e_1_2_18_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.25285"},{"key":"e_1_2_18_22_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijns11020024"},{"key":"e_1_2_18_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2012.12.003"},{"key":"e_1_2_18_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.24254"},{"key":"e_1_2_18_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2008.07.005"},{"key":"e_1_2_18_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.27506"},{"key":"e_1_2_18_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.27235"},{"key":"e_1_2_18_28_1","unstructured":"\u201cCFRISE CF Resources \u201d Accessed September 9 2025 https:\/\/cfrise.com\/cf-resources."},{"key":"e_1_2_18_29_1","doi-asserted-by":"publisher","DOI":"10.4314\/ahs.v20i1.51"},{"key":"e_1_2_18_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.25351"},{"key":"e_1_2_18_31_1","first-page":"d4662","article-title":"Association Between Socioeconomic Status, Sex, and Age at Death From Cystic Fibrosis in England and Wales (1959 to 2008): Cross Sectional Study","volume":"343","author":"Barr H. L.","year":"2011","journal-title":"BMJ (London)"},{"key":"e_1_2_18_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2024.10.010"},{"key":"e_1_2_18_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.71037"},{"key":"e_1_2_18_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.27051"},{"key":"e_1_2_18_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2025.10.007"},{"key":"e_1_2_18_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.27181"},{"key":"e_1_2_18_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.27249"},{"key":"e_1_2_18_38_1","unstructured":"\u201cEuropean Cystic Fibrosis Society \u201d Registry Project Outside Europe Accessed September 10 2025 https:\/\/www.ecfs.eu\/projects\/ecfs-patient-registry\/registry-project-outside-europe."},{"key":"e_1_2_18_39_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202307-1200VP"},{"key":"e_1_2_18_40_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24076351"},{"key":"e_1_2_18_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-025-03707-9"},{"key":"e_1_2_18_42_1","doi-asserted-by":"publisher","DOI":"10.5152\/TurkArchPediatr.2025.24257"},{"key":"e_1_2_18_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.25852"},{"key":"e_1_2_18_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcf.2023.09.003"},{"key":"e_1_2_18_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.26041"},{"key":"e_1_2_18_46_1","unstructured":"\u201cMiddle East Cystic Fibrosis Association \u201d Annual Report 2019 Accessed September 8 2025 https:\/\/www.mecfa.org\/2019-annual-report."},{"key":"e_1_2_18_47_1","unstructured":"S.NolenandR.Robbins \u201cThe Drug is a \u2018Miracle\u2019 but These Families Can't Get it \u201dThe New York Times 2023 https:\/\/www.nytimes.com\/2023\/02\/07\/health\/cysticfibrosis-drug-trikafta.html."},{"key":"e_1_2_18_48_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2023.1163391"}],"container-title":["Pediatric Pulmonology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ppul.71560","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ppul.71560","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ppul.71560","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T13:57:25Z","timestamp":1790344645000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ppul.71560"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":47,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/ppul.71560"],"URL":"https:\/\/doi.org\/10.1002\/ppul.71560","archive":["Portico"],"relation":{},"ISSN":["8755-6863","1099-0496"],"issn-type":[{"value":"8755-6863","type":"print"},{"value":"1099-0496","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"2025-10-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71560"}}