Abstract Rationale: Higher neighborhood-level disadvantage is associated with lower baseline lung function in patients with fibrotic interstitial lung disease (fILD), but the association of disadvantage with radiologic features and patterns remains unknown. Methods: Patients with fILD enrolled in the Canadian Registry for Pulmonary Fibrosis were evaluated in standardized multi-disciplinary discussion (MDD). Expert chest radiologists blinded to clinical data evaluated baseline computed tomography scans, visually quantifying the percentage of lung parenchyma affected by honeycombing, reticulation, ground glass opacities (GGO), and hypoattenuating lung and determining the top radiologic pattern (usual interstitial pneumonia=UIP, fibrotic hypersensitivity pneumonitis=fHP, non-specific interstitial pneumonia=NSIP, “no confident pattern”). Clinical data was introduced, and a top clinical diagnosis was assigned by the radiologist and an ILD clinician. Neighborhood disadvantage was assigned to patient residential locations using the Canadian Index of Multiple Deprivation (CIMD) score and its 4 domains (residential instability, ethnocultural composition, economic dependency, situational vulnerability), with higher scores reflecting greater disadvantage. Linear models adjusted for age, sex, smoking, race, and baseline lung function evaluated associations of CIMD score with percentage of radiologic features. Multinomial models adjusting for the same covariates determined associations of CIMD score with radiologic pattern, using UIP as the reference. Results: Of 1473 patients included, the most common diagnoses were CTD-ILD (48%), IPF (29%), and fHP (16%). Higher CIMD score (range: -1.07 to 2.57) was associated with 0.62% increased honeycombing (95%CI=0.02-1.23, p=0.04, Table). Higher ethnocultural composition score (indicating neighborhoods with higher foreign-born, immigrant, minoritized, or linguistically-isolated individuals) was associated with less reticulations and increased pure GGO. Higher CIMD score was not associated with greater odds of fHP or NSIP patterns as compared with UIP, although higher ethnocultural composition score was associated with higher odds of NSIP (OR=1.18, 95%CI=1.01-1.39, p=0.04). Within patients with a top MDD diagnosis of IPF, higher total CIMD and ethnocultural scores were associated with more honeycombing. In CTD-ILD, higher residential instability was associated with more honeycombing and higher ethnocultural composition score with more hypoattenuating lung. In fHP, none of the scores were associated with worse honeycombing, reticulations, GGO, or hypoattenuating lung. Conclusions: Neighborhood disadvantage is associated with worse honeycombing, supporting prior findings that patients living in more disadvantaged areas present to tertiary ILD care with greater disease burden. Increased ethnocultural composition scores were associated with increased extent of inflammatory features in CTD-ILD and higher odds of an NSIP pattern, suggesting possible demographic, geographic, and/or genetic risk factors for this type of fILD.