B42-28 Longer Travel Distance to Subspecialty Care but Not Rural Community Living Associates With Lower Lung Function in Patients With Pulmonary Sarcoidosis

Rationale Sarcoidosis is a multisystem granulomatous disease that requires comprehensive, multidisciplinary care (Moor 2020); however, most sarcoidosis centers are in urban areas. In patients with pulmonary fibrosis, both travel distance and rurality associate with poor lung function and survival (Johannson 2022, DeDent 2022). These relationships are unexamined in sarcoidosis. We evaluated whether travel distance to subspecialty care and/or rurality associates with lower lung function in patients with pulmonary sarcoidosis. Methods We retrospectively analyzed patients with biopsy-confirmed pulmonary sarcoidosis newly referred to the University of Virginia Sarcoidosis Center of Excellence in 2019 (IRB #20937). Home addresses were geocoded for travel distance and assigned Rural-Urban Commuting Area (RUCA) codes according to the U.S. Department of Agriculture Economic Research Service (ERS). RUCA 1-3 are defined metropolitan and 4-10 rural by ERS. Primary outcomes were percent-predicted-FVC (FVC%), percent-predicted-DLCO (DLCO%), and Six-minute-walk-distance (6MWD), representing disease severity at presentation. We defined far travel distance based on 75th percentile distance from center (85 miles). Multivariable regression models examined associations between lung function, travel distance and rurality, adjusting for clinical variables including age, sex, race, smoking, employment, and treatment status. Shapiro-Wilk assessed feasibility of model linearity assumption. Results Among 120 referrals, 100 met inclusion criteria (14 were excluded for unavailable geocoding, 6 lacking biopsy confirmation). Patients were 53% male , 61% self-identified White race, with mean FVC 3.58 L (87%), DLCO 23.4 mL/min/mmHg (81%), and 6MWD 312 meters. No significant demographic differences existed across travel distance or RUCA groups. In unadjusted analysis, patients in the far group had significantly lower FVC% compared with the near group, while DLCO% and 6MWD did not differ significantly. After adjustment for clinical variables including sex, race, age and treatment status, greater travel distance remained associated with an 8% lower FVC (p = 0.025, 95% CI (-15.786, -1.2)). No significant differences in lung function were found between metropolitan and rural groups (Figure 1). Conclusion Among patients with pulmonary sarcoidosis referred to Sarcoidosis Center of Excellence care, greater travel distance but not rural community living was associated with lower lung function at presentation. This association persisted regardless of age, sex, race, treatment and employment status. The degree of lung function impairment was greater than the improvement measured in high-quality treatment trials for sarcoidosis (Kahlmann 2025). Our findings suggest that geographic barriers to care may contribute to delayed referral and greater disease burden and are an important target for improving care in patients with sarcoidosis. This abstract is funded by: NIH NHLBI K23 HL143135