Health disparities and associated social determinants of health in interstitial lung disease: a narrative review.

Abstract

Background: Health disparities are prevalent across respiratory diseases. Social determinants of health are closely associated with health disparities and account for between 30% and 55% of all health outcomes. In people with interstitial lung disease (ILD), disparities have the potential to significantly impact access to care and health outcomes along many stages of the disease journey.

Aim: This review aimed to provide an overview of health disparities in ILD, focusing on the determinants of health and access to care from diagnosis to end of life and to report on some approaches being proposed to address these disparities.

Methods: A narrative review of the literature was undertaken using three electronic databases (Ovid Embase, Medline and CINAHL) from inception to May 2024. Disparities and social determinants were mapped to the domains of the Dahlgren-Whitehead model of social determinants of health.

Results: A total of 31 studies were eligible for inclusion. Common disparities identified included differences in antifibrotic utilisation, representation in clinical trials, access to ILD care and lung transplantation waiting lists. Associated social determinants included race/ethnicity, gender, geography and socioeconomic status. Paradoxically, telehealth technology and utilisation have the potential to improve access to diagnostic and treatment options for marginalised communities but may exacerbate disparities for those with lower digital literacy and access.

Conclusion: Reducing health disparities in ILD will require an awareness and understanding of the root cause of the disparities at both the individual and societal level in order to develop effective interventions that improve access to care for all living with ILD.