Background: There have been no previous comprehensive reports on interstitial lung diseases (ILD) in Israeli population, that may have unique epidemiological features. We aimed to explore ILD in Israel, with an emphasis on disparities between different regions of the country. Methods: The study included consecutive patients with a multidisciplinary diagnosis of ILD, using data from registries of four tertiary medical centers (MC) located in Central and Northern Israel. Multivariate regression models were used to assess the region of residence (peripheral vs. central) as an independent predictor for ILD subtypes. Results: Included were 927 patients with ILD (mean age 67 ± 13, 40% females). Most patients (56–61%) reported working in at least one job that involved relevant inhalational exposures. Despite the geographic proximity of MCs (all within 100 km), significant variations in demographic and clinical characteristics were observed, including age, sex, exposures, and ILD diagnoses (p < 0.01). The most prevalent diagnoses were Idiopathic pulmonary fibrosis (IPF, range 13–58%) and autoimmune-related ILD (11–30%). In peripheral areas, the diagnosis of IPF was more frequent (53% vs. 24%, p < 0.01), while exposure-related ILD (5% vs. 16%, p < 0.01) and autoimmune-related ILD (16% vs. 25%, p < 0.01) were more frequent in central Israel. In multivariate analysis, peripheral residence remained an independent predictor for IPF (AOR 2.95, 95% CI 2.1–4.1) and central residence for exposure-related ILD (AOR 0.46, 95% CI 0.33–0.63). Conclusions: Variations in ILD characteristics were observed between centers in close geographic proximity, highlighting disparities between peripheral and central Israel, and the need for personalized assessment based on local frequencies and exposures.

Introduction: Interstitial lung disease (ILD) encompass over 200 disorders that diffusely affect the lung parenchyma. There have been no previous reports on ILDs in the Israeli population, that may have unique characteristics. Aims and Objective: To describe the characteristics of ILDs in Israel, using data of over 1000 patients from four large medical centers (MC). Methods: All registries were retrospective, except that of Tel Aviv MC which was prospective. Sarcoidosis patients were included provided they had interstitial lung involvement. Results: The four main districts (Dan, Center, Haifa, Northern) that are serviced by our four MCs are home to 67.8% of Israel’s population (Figure 1A). In Tel Aviv and Meir MCs, there was equal representation for males and females, while male sex was more prevalent in Sheba MC (58%) and Carmel MC (68%). Most patients (range 56%-59%) in each MC worked in at least one job that involved inhalational exposure to substances. Figure 1B depicts the relative frequency of ILD diagnoses in each MC. In Tel Aviv and Meir MCs, the most common diagnosis was autoimmune ILD (27% and 25%, respectively), while in Carmel and Sheba MCs it was IPF (58% and 31%). Age, % males, and mean pack-years were highest in Carmel MC, potentially explaining the unusually high frequency of IPF. Conclusions: There was significant variation between different centers in Israel in sex, age, smoking, exposures, and ILD diagnoses, despite Israel being a relatively small country.

Cardiovascular comorbidities complicate interstitial lung disease (ILD) and represent potential therapeutic targets, yet the prevalence and clinical impact of left ventricular diastolic dysfunction (LVDD) remain poorly characterized. We aimed to evaluate LVDD as a potential treatable trait within a prospective cohort. Using data from an ILD registry (January 2021–October 2024), we defined clinically relevant LVDD as echocardiographic grade 2 or 3 diastolic dysfunction. Out of 276 patients (median age 69, 44% female), 14% had LVDD, which was almost entirely in patients with fibrosis (97%, p = 0.045) and associated with lower diffusing capacity for carbon monoxide. Survival and clinical analyses restricted to the fibrotic ILD subgroup (n = 241) showed that LVDD was independently associated with a higher hazard for a combined adverse outcome of acute exacerbation, lung transplantation, or death (adjusted HR 1.82, 95% CI 1.03–3.38, p = 0.043), which persisted after 1:2 propensity score matching (HR 2.04). LVDD also independently predicted increased all-cause mortality (adjusted HR 2.10) and reduced 6-min walk distance (median 413 vs. 465 m, β = −0.14, p = 0.036). In conclusion, LVDD is prevalent in fibrotic ILD and carries significant prognostic implications. Given its objective measurability and actionable treatment pathways, LVDD represents a potentially important treatable trait requiring multi-disciplinary care.