Social Disparities and Community Resilience in ILD-Related Mortality Across US Counties

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Abstract RATIONALE: Interstitial lung disease (ILD) is a heterogeneous group of lung disorders characterized by inflammation and/or scarring of lung tissue. Coexisting comorbidities are common among patients with ILD and significantly contribute to the economic burden of the disease. However, there is limited research on the complex relationships between ILD outcomes, associated comorbidities, and various measures of social disadvantage across US counties. Our study aimed to assess the association between different county-level social determinants indices and ILD-related mortality in the presence of comorbidities in the US. METHODS: County-level ILD-related mortality data from 2016-2020 were obtained from the Centers for Disease Control and Prevention, Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). We also obtained mortality data for ILD with common coexisting comorbid conditions, including cardiovascular diseases (CVD), chronic lower respiratory diseases (CLRD), diabetes mellitus (DM), cancer, pulmonary hypertension (PH), and influenza/pneumonia, from CDC WONDER. The study examined various county-level indices of social determinants, such as the National Risk Index [NRI = Expected Annual Loss(EAL) × Social Vulnerability(SVI) / Community Resilience(BRIC)] and the Social Deprivation Index (SDI). Both NRI and SDI, originally presented as percentile rankings, were further classified into quartiles for analysis. Negative binomial regression models were used to analyze the associations between ILD mortality with coexisting comorbidities and different health indices. RESULTS: From 2016-2020, the age-adjusted ILD-related mortality rate per 1,000,000 population was 88.8 (95% CI: 88.4-89.2). Counties with greater social vulnerability, deprivation, and lower community resilience showed significantly higher ILD-related mortality. Similarly, mortalities for ILD with coexisting comorbidities of CVD, CLRD, DM, or influenza/pneumonia were significantly greater in counties with higher levels of vulnerability, deprivation, and lower resilience. Notably, the proportional increase in mortality was more pronounced for ILD with coexisting CLRD, DM, or influenza/pneumonia than for ILD alone. Adults aged <65 years, females, Whites, and rural area had the highest relative increase in ILD-related mortality. Interestingly, a paradoxical relationship was observed between ILD-related mortality and National Risk Index and Expected Annual Loss. CONCLUSIONS: There are significant disparities in ILD mortality across US counties, which are strongly associated with social disadvantage as measured by social vulnerability, deprivation, and community resilience. This effect was particularly pronounced in individuals with comorbid conditions like CLRD, DM, and influenza/pneumonia. These findings highlight the critical role of social determinants of health and community resilience in shaping ILD outcomes and emphasize the need for targeted interventions to address these disparities, especially in socially disadvantaged areas.

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