Longer travel distance to subspecialty ILD clinic tied to worse clinical outcomes

Longer travel distance to a subspecialty interstitial lung disease clinic was associated with worse clinical outcomes for patients with fibrotic ILD than those who live closer, researchers reported in Annals of the American Thoracic Society.

“Patients with ILD traveling a longer distance to receive their subspecialty care had less severe disease but were more likely to undergo lung transplantation and had a higher risk of death than patients who lived closer to their ILD clinic,” Kerri A. Johannson, MD, MPH, clinical associate professor in the departments of medicine and community health sciences at the University of Calgary in Alberta, Canada, and colleagues wrote.

Researchers analyzed data from 1,162 patients with fibrotic ILD (mean age, 63 years; 49% men) recruited from a multicenter pulmonary fibrosis registry in Canada. Using residential postal codes, researchers estimated travel distance from patients’ homes to the ILD clinic; “near” a center was characterized as a distance within 70 km and “far” from a center was characterized as a distance of more than 70 km.

Overall, 856 patients lived near their ILD clinic and 306 lived far from their ILD clinic. The median distance to an ILD clinic was 30 km for the total cohort, 20 km for those living closer and 185 km for those living farther away. Those who lived farther from their ILD clinic were younger (62 years vs. 63 years), more likely to smoke (22 pack-years vs. 26 pack-years), had greater 6-minute walk distance (419 m vs. 386 m) and had lower composite risk scores in GAP (gender-age-physiology) score (3.32 vs. 3.98) compared with those who lived closer.

Patients who lived farther from their center also had a greater risk for mortality or lung transplant compared with those living closer when adjusting for age, sex and baseline FVC (HR = 1.52; 95% CI, 1.1-2.11; P = .01).

This finding was predominantly driven by patients with connective tissue disease-related ILD (HR = 2.14; 95% CI, 1.16-3.94; P = .02), according to the researchers.

“These findings suggest a likely referral bias, with older patients at higher risk of death who live in remote locations being less frequently assessed at ILD subspecialty clinics, identifying a group of patients who may be receiving suboptimal ILD care,” the researchers wrote. “Future work is needed to clarify the reasons for this potential inequity and to develop and test innovative programs that improve access to subspecialty clinical care for all patients with fibrotic ILD.”