Abstract Background Urbanrural status may influence access to specialized care and medication management for patients with interstitial lung disease (ILD). This study examined whether urbanicity explains differences in (1) pulmonologist consultation and (2) prescription of ILD medications among individuals diagnosed with ILD. Methods We performed a retrospective cohort analysis of all patients who received an International Classification of Diseases (ICD 9 and ICD 10) diagnosis code for ILD between January 1 2010 and December 31 2022. Data were extracted from the MDClone platform and the Corporate Data Warehouse (CDW). An analytical repository integrating electronic medical records, billing, pharmacy, and laboratory information. Each patient record is deidentified yet contains a stable unique identifier that permits linkage across data domains. We calculated the frequency of pulmonologist consultations and ILDspecific medication prescriptions. Multivariate Cox proportionalhazard models were used to assess the association between level of urbanicity (highly rural, rural, urban) and the time to first pulmonologist visit and to first prescription, adjusting for demographic covariates. Results The cohort contributed 9 756 739.4 personmonths of followup over 12 years. Approximately 20 % of ILD patients were evaluated by a pulmonologist, and 8 % received a prescription for an ILD medication. Cox-models revealed that residents in highly rural (HR = 0.67, 95 % CI 0.57-0.79) and rural (HR = 0.82, 95 % CI 0.79-0.85) areas had significantly lower hazards of pulmonologist consultation compared to urban dwellers, respectively. No statistically significant differences were observed in the hazards of medication prescribing across urbanicity strata (p 0.05). Conclusion Rural veterans with ILD are less likely to receive specialized pulmonary care than their urban counterparts. Although medication prescribing patterns appear homogeneous across settings, antifibrotic therapy remains underutilized in Veterans compared to the general population. Targeted interventions to bridge geographic gaps in specialist access could mitigate disease progression and improve outcomes for ILD patients residing in rural communities. This abstract is funded by: Veteran Health Administration/Office of Rural Health
Manjarres et al. (Fri,) studied this question.