B41-34 Exploring Disparities in Acute Exacerbations of Systemic Autoimmune Related Interstitial Lung Disease at an Urban Quaternary Referral Center

Abstract Rationale Acute exacerbations (AE) of non-idiopathic pulmonary fibrosis interstitial lung disease (ILD) have mortality rates of 33-83%. The majority of these patients have ILD related to systemic autoimmune rheumatic disease (SARD-ILD). Multiple disparities exist for minorities including decreased survival, lower transplant rates, and decreased antifibrotic utilization. We investigate clinical outcomes during and after AE-SARD-ILD for patients with different racial and ethnic backgrounds. Methods 46 patients with AE-SARD-ILD requiring hospitalization between 2015-2025 were identified in retrospective chart review. Demographic data including race and ethnicity along with outcomes were identified and collected. Statistical analysis was conducted including chi-square, analysis of variance (ANOVA), and Kaplan-Meier survival analysis. Results 39% of patients hospitalized for SARD-ILD flare were Black, 28% White, 15% Hispanic, 2% Asian, and 15% other/unknown. 61% of patients were female. Hispanic patients were younger than White patients at admission (50.8 +/- 12.8 years vs 65.8 +/- 5.8 years, p = 0.002); Black patients were between them in age (59.5 +/- 11.7 years). In-hospital mortality was 35% overall, with no significant difference in mechanical ventilation, ICU admission, or in-hospital mortality by race/ethnicity. Survival after ILD flare (p 0.0001) and transplant-free survival after ILD flare (p = 0.001) were significantly different by race/ethnicity. 1-year mortality rate after ILD flare was 52% overall, 55% for Black patients, 31% for white patients, and 43% for Hispanic patients (p = 0.037). About 20% of patients received a lung transplant, 46% of White patients, 17% of Black patients, and 0% of all other races/ethnicities (p = 0.048). There was no significant difference in antifibrotic utilization. Discussion AE-SARD-ILD is associated with high morbidity and mortality. There were few differences in inpatient outcomes by race/ethnicity in this cohort. However, disparities in age at AE-SARD-ILD, transplant, and survival suggest broader inequities. Differential outcomes are likely multifactorial, including diagnostic delays and access to outpatient care. Previous studies have shown Black and Hispanic patients with IPF to have lower access to transplant; this was similar in our patients after admission for AE-SARD-ILD. Our center’s experience demonstrates the need to treat patients with AE-SARD-ILD in an intersectional, health justice-oriented manner to address disparities in diagnosis, treatment, and outcomes. This abstract is funded by: None