Travel Distance to Subspecialty Clinic and Outcomes in Patients with Fibrotic Interstitial Lung Disease
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RATIONALE: Early access to subspecialty care is associated with improved outcomes for patients with fibrotic interstitial lung disease (ILD). Access to ILD care may be limited for patients living far from subspecialty clinics. OBJECTIVE: To test the hypothesis that greater travel distance to access ILD clinical care would be associated with more severe disease at time of referral and worse clinical outcomes. METHODS: Patients with fibrotic ILD were recruited from a multicenter national pulmonary fibrosis registry. Residential postal codes were geocoded to estimate travel distance from home to clinic. Travel distance was dichotomized at ≤70km (near) and >70km (far). Demographics and disease severity at initial referral, change in lung function, and risk of death or transplant were analyzed in unadjusted and adjusted models for their association with travel distance. RESULTS: The cohort included 1162 patients, of whom 856 lived near and 306 lived far from their ILD clinic. Patients residing farther from clinic were younger, more likely to have smoked, had greater 6-minute walk distance, and lower composite risk scores compared to patients residing closer to clinic. In models adjusted for age, sex, and baseline forced vital capacity, patients from farther away had greater risk of death or lung transplant compared to patients residing closer (HR=1.52 95%CI 1.10 to 2.11), a finding predominantly driven by patients with connective-tissue disease (CTD) associated ILD (HR=2.14 95%CI 1.16 to 3.94). CONCLUSIONS: Patients with fibrotic ILD with a longer travel distance to their ILD clinic had better prognostic indices at baseline, but a higher risk of death or lung transplant in the total cohort and in patients with CTD-ILD. Assuming that disease epidemiology and severity are distributed evenly across geographic regions, these findings raise important questions about equitable access to patient care in large healthcare regions with centralized subspecialty programs.
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