Abstract Introduction Social determinants of health (SDH) are increasingly recognized as contributory toward health outcomes in patients with interstitial lung disease (ILD). While environmental exposures and comorbid conditions, for instance, are linked to both social determinants of health and ILD outcomes, additional markers of this multifaceted aspect remain unexplored. In this study we aim to identify how insurance status, used as a surrogate of underlying socioeconomic constraints, affects ILD outcomes. Methods Patients seen at the University of Chicago ILD clinic and consented for the Natural History database were included in this study. Demographics, insurance status, baseline pulmonary function, immunosuppressive and/or antifibrotic use, and survival data were abstracted from the medical record. ILD subtype was determined via multidisciplinary diagnosis (MDD) via consensus guidelines. CT progression was defined as occurring based on the chest radiologist’s report of any increase in reticulation or progression of fibrosis. T-tests along with linear and logistic regression were performed when appropriate to assess the relationship between insurance status, demographics, and baseline lung function. Logistic regression was performed assessing for the relationship of insurance status to medication use adjusted for gender-age-physiology (GAP) score, smoking, race, and MDD. Survival analysis was performed via Kaplan-Meier curves and Cox proportional hazard regression with the same adjustment for confounders. Results One hundred seventy-nine patients were included in this analysis (IPF=29 patients, CTD-ILD=68 patients, IPAF=8 patients, HP = 20 patients, sarcoidosis=22 patients, other diagnosis=32 patients). Compared to private insurance or Medicare, Medicaid status was associated with non-White race (HR 2.54, 95% CI 0.80-8.09) and lower baseline lung function (FVC 55% predicted in patients on Medicaid and 67% in patients on private insurance or Medicare, p = 0.006; DLCO 40.5% in patients on Medicaid and 60% in patients on private insurance or Medicare, p = 0.003). Medicaid status was significantly associated with worse transplant-free survival after multivariable adjustment (HR 2.16, 95% CI 1.07-4.38). However, Medicaid status was not significantly associated with radiologic progression of ILD (HR 1.02, 95% CI 0.31-3.42), antifibrotic use (HR 0.62, 95% CI 0.07-5.30), or immunosuppressive use (HR 1.56, 95% CI 0.45-5.42). Conclusions Our data demonstrates that ILD patients with Medicaid have lower baseline lung function and worsened transplant-free survival, but no differential medication use. Our findings demonstrate that Medicaid status may be an acceptable surrogate marker for SDH factors that impact survival in patients with ILD beyond the use of ILD-specific treatment. Future efforts to mitigate socioeconomic barriers will be paramount in improving ILD outcomes. This abstract is funded by: None
Agwaramgbo et al. (Fri,) studied this question.