A comparative analysis of interstitial lung disease in the systemic autoimmune rheumatic diseases using All of Us data

Abstract

Abstract Background: Systemic autoimmune rheumatic diseases (SARDs) affect millions in the United States and are associated with substantial morbidity, particularly in patients with interstitial lung disease (ILD). However, risk factors for SARD-ILD across diseases in diverse, contemporary populations remain unclear. We hypothesized that cigarette smoking would be strongly associated with ILD across SARDs. Methods: Using the All of Us dataset (>600,000 participants), we identified 9,546 participants with SARD and 710 with SARD-ILD using rule-based algorithms. Logistic regression assessed associations of age, sex, and smoking with ILD; lung cancer and IPF served as positive controls. Results: ILD prevalence was 7.4% in the overall SARD cohort and varied across diseases. Age was strongly associated with ILD (OR 1.20, 95% CI 1.12–1.28), while smoking was not (OR 1.06, 95% CI 0.89–1.25). Smoking was strongly associated with lung cancer (OR 3.92) and IPF (OR 1.37). Conclusion: Smoking was not strongly associated with SARD-ILD, suggesting disease-specific or non-smoking-related mechanisms for the development of SARD-ILD in large, contemporary populations.