Individuals in close proximity to care for interstitial lung disease (ILD) did not have significantly improved outcomes than those at a greater distance, based on data from more than 1600 individuals and presented at American College of Chest Physicians (CHEST) 2025 Annual Meeting.

“Examining the impact of geographic distance and social vulnerability on interstitial lung disease care and outcomes is essential, as access barriers disproportionately affect high-risk groups and may drive disparities in care quality and health outcomes,” said lead author Arianne K. Baldomero, MD, a pulmonologist and assistant professor of medicine at the University of Minnesota, Minneapolis, in an interview.

Baldomero and colleagues used data from a national ILD registry cohort, the Pulmonary Fibrosis Foundation Patient Registry. The study population included 1640 individuals (mean age, 72.1 years), divided into tertiles based on distance to an ILC Care Center Network and Social Vulnerability Index (SVI) data to define vulnerable communities. The SVI ranks counties based on social factors including socioeconomic status, household composition, housing, and transportation.

The distance tertiles were 16.1 miles or less from specialty care, 16.2-51.1 miles away, and more than 51.1 miles away. The SVI tertiles were the 34th percentile or less, the 35th to 68th percentile, and the 69th percentile or higher.

The researchers analyzed healthcare utilization (clinic visits, pulmonary function tests, CT scans, pulmonary rehabilitation, lung biopsy, and pulmonary rehabilitation) and clinical outcomes (death, lung transplant, acute exacerbation, respiratory hospitalization, PFT decline). Adjusted hazard ratios (HRs) controlled for age, sex, race, ethnicity, and tobacco history.

Overall, greater distance from care was associated with significantly fewer clinic visits between tertiles 3 and 1 (2.3 vs 3.0; P < .001). However, patients from more disadvantaged areas (the highest tertile SVI) had significantly greater access to pulmonary rehabilitation (34.8% vs 26.4%, P = .02) and more lung biopsies (5.2% vs 1.4%; P = .001).

Patients at the greatest distance had less access to pulmonary rehabilitation than those closer to care, but the difference was not significant (27.9 vs 32.2%; P = .06).

Additionally, individuals living farthest from specialty care had a lower risk for both acute exacerbations and respiratory hospitalizations than those closest to care (HRs, 0.67 and 0.76, respectively). Scores on the SVI were not significantly associated with time to death or transplant, acute exacerbations, respiratory hospitalizations, or declines in either forced vital capacity or diffusing capacity of the lung for carbon monoxide.

The finding that increased distance and social disadvantage led to less healthcare utilization without worsening adjusted clinical outcomes was unexpected, suggesting unmeasured factors or disparities in disease severity or healthcare-seeking behavior, Baldomero told Medscape Medical News.

The results suggest that “while access barriers reduce healthcare utilization, clinical outcomes may not always be negatively impacted, highlighting the need to individualize care and leverage outreach strategies for vulnerable ILD patients,” she said.

“Additional research should include studying ILD patients outside of registry cohorts, such as those in broader healthcare systems, to better understand real-world barriers, outcomes, and disparities,” said Baldomero. “Expanding research to these populations may uncover challenges and solutions that registries alone cannot capture, ensuring interventions are broadly applicable,” she added.

Managing the Growing ILD Population

ILD, though still rare, is rising with the aging population, said Rachel Criner, MD, assistant professor of thoracic medicine and surgery at the Lewis Katz School of Medicine at Temple University, Philadelphia, in an interview.

ILD is a rapidly progressive disease with a high mortality rate; therefore, it is imperative to study any potential barriers to delivering evidence-based, efficient, and thorough patient care to improve patient outcomes, said Criner, who was not involved in the study.

“Patients can seek out ILD centers of excellence, where they can discuss their care with pulmonologists who have ILD expertise to ensure that they are receiving all recommended treatments, and to learn about additional options, such as support groups and clinical trials,” Criner told Medscape Medical News. Many ILD centers of excellence allow telemedicine visits, as well as options for remote pulmonary rehabilitation, which can help remove barriers to access for some patients, she said. “The ability to participate in rehab at home is crucial to patients who live far from a rehab center and/or have difficulty traveling because of their disease severity,” Criner noted.

Takeaways and Next Steps

“Reassuringly, the current study did not find worse outcomes in ILD patients who live far from a specialized ILD center and/or who are socially disadvantaged; however, it shows that care for this disease is complex with frequent multimodal monitoring needed,” Criner told Medscape Medical News. To that end, “it is crucial that ILD centers partner with community physicians and patients to provide the best care for patients,” she said.

Idiopathic pulmonary fibrosis was the predominant ILD subtype presented in this study, but only 39.8% of total ILD patients were on antifibrotic therapy, which seems disproportionately low, Criner said. Questions for future research include reasons for this apparent discrepancy, and whether antifibrotic prescribing practices differ based on patient’s distance to care or SVI, Criner added.

This study received no outside funding. Baldomero disclosed no financial conflicts of interest. Criner disclosed no financial conflicts of interest.