C55-25 Racial Disparities in Acute Respiratory Distress Syndrome Patients With Interstitial Lung Disease: A Nationwide Analysis

Abstract Rationale Acute respiratory distress syndrome (ARDS) in patients with interstitial lung disease (ILD) represents a complex overlap of acute inflammatory injury and chronic fibrotic remodeling, often leading to poor outcomes and limited ventilatory reserve. Prior studies have described epidemiologic differences in ARDS outcomes, yet racial and ethnic disparities in the specific subgroup of ILD-associated ARDS remain underexplored. Understanding these disparities is critical for identifying inequities in disease recognition, healthcare access, and treatment outcomes across diverse populations. Methods A retrospective cross-sectional study was conducted using the Healthcare Cost and Utilization Project National Inpatient Sample (NIS) from 2016 to 2020. Adult hospitalizations with ARDS requiring mechanical ventilation were identified using ICD-10 codes. Patients were stratified according to the presence of comorbid ILD, with non-ILD ARDS serving as the comparison group. Weighted national estimates were obtained using the NIS’s complex survey design incorporating clustering, stratification, and sample weights. Continuous variables were summarized as weighted means with standard errors (SE), and categorical variables as weighted frequencies and percentages. Between-group comparisons were performed using the weighted t-test for continuous variables and the Rao-Scott modified chi-square test for categorical variables. Multivariable logistic regression was used to assess the independent association of race with ILD-related ARDS after adjusting for demographic, clinical, and hospital-level characteristics. Results Among an estimated 165,055 adult hospitalizations for ARDS requiring mechanical ventilation, 3,295 (2.0%) involved patients with ILD. Marked racial and ethnic disparities were identified (p 0.0001). White patients accounted for 63.0% of ILD-related ARDS versus 52.8% of non-ILD ARDS. In contrast, Black (12.3% vs 16.8%) and Hispanic (11.7% vs 17.1%) patients were significantly underrepresented. In adjusted models, White race was independently associated with a higher likelihood of ILD-related ARDS (aOR 1.42, 95% CI 1.25-1.60), whereas Black (aOR 0.78, 95% CI 0.69-0.88) and Hispanic (aOR 0.74, 95% CI 0.65-0.85) race were associated with lower odds. Mortality remained high across all racial groups but did not significantly differ after adjustment. Conclusions Significant racial disparities exist among ARDS patients with ILD, with White individuals disproportionately affected compared to Black and Hispanic populations. These differences may reflect true epidemiologic variation in ILD prevalence, differential diagnostic recognition, and inequities in access to specialty pulmonary care. Recognition of these disparities is essential to promote equitable diagnostic evaluation, improve ILD screening among minority populations, and ensure diverse representation in clinical research addressing ARDS and fibrotic lung diseases. This abstract is funded by: None