Abstract Rationale Interstitial lung disease (ILD) encompasses a broad group of lung disorders that cause inflammation and scarring of lung tissue. Climate change may adversely affect ILD through increased air pollution, which is increasingly recognized as a risk factor for its development and progression. However, the impact of climate change skepticism on ILD mortality remains unclear. Methods County-level ILD-related mortality data (2016-2020) were obtained from CDC WONDER, and county-level climate change skepticism data were collected from the Yale Program on Climate Change Communication. Associations between ILD-related mortality and quartiles of climate change skepticism were analyzed using negative binomial regression, stratified by age, sex, race, urbanization, and comorbidities. Mediation analyses examined potential pathways (PM2.5, influenza and pneumococcal vaccination rates, and smoking rate) through which climate change skepticism may affect ILD-related mortality, adjusting for community vulnerability. Results This cross-sectional study included 1408 US counties for the analysis of ILD-related mortality. Higher mortality rates were observed in counties with increased climate change skepticism (4th vs. 1st quartile, rate ratio RR: 1.08; 95% CI: 1.04-1.14). The effects of climate change skepticism were strongest for mortality attributed to ILD with concomitant chronic lower respiratory disease (CLRD, RR: 2.42; 95% CI: 1.85-3.17) and diabetes (RR: 1.25; 95% CI: 1.14-1.37), and among Black populations (RR: 1.32; 95% CI: 1.15-1.52). Smoking significantly mediated the relationship between climate change skepticism and ILD-related mortality, with approximately 52% of the effect explained by increased smoking prevalence. No significant mediation effects were observed for PM2.5 or vaccination rates at the county level. Conclusions Greater climate change skepticism is associated with higher ILD-related mortality. Targeted public health policies and interventions addressing climate change skepticism-related health behaviors, such as smoking, are important for reducing ILD-related mortality and associated health disparities in disadvantaged areas. This abstract is funded by: None
Chang et al. (Fri,) studied this question.