Specialist ILD clinic care was associated with more antifibrotic use and lower hospitalisation and death

Design

Retrospective cohort, single academic health system

Population

6,637 adults with ILD

Primary outcome

Guideline-concordant care, hospitalisation, ED visits, death

Effect

Death HR 0.57 (0.45-0.72); hospitalisation HR 0.46 (0.42-0.51)

A retrospective cohort in Chest, published on 28 October 2026, followed 6,637 adults with interstitial lung disease in one US academic health system; 66% were seen in a subspecialty ILD clinic and 34% elsewhere.

Patients seen outside the ILD clinic were more often Black or Latinx, from more deprived neighbourhoods and with an unspecified ILD diagnosis. After adjustment, ILD clinic care was associated with more chest CT (OR 2.51), more antifibrotic therapy (OR 1.54), fewer lung biopsies (OR 0.47), and lower hazards of hospitalisation (HR 0.46), emergency visits (HR 0.68) and death (HR 0.57).

The associations are large but observational; sicker or more complex patients may differ between settings in ways not captured. The equity finding is the more robust one: those with least access to specialist care are already the more disadvantaged.

• Refer patients with suspected or unclassified fibrotic ILD to a specialist ILD service or multidisciplinary discussion.
• Use telemedicine or remote MDT review where a specialist clinic is not accessible.
• Avoid labelling ILD as 'unspecified' without a structured diagnostic work-up.
• Review antifibrotic eligibility for patients with progressive fibrosis.

Why it matters

Unequal access to ILD expertise may translate into unequal outcomes.

Don't overread it

Observational, single-system data; it cannot show specialist care itself caused better survival.

The statistics, in plain English

A hazard ratio of 0.57 for death means about 43% lower adjusted risk, but residual confounding — differences between patients that adjustment missed — could explain part of it.

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