PO:33:190 | Travel distance to tertiary healthcare reflects disease severity and medication access in systemic sclerosis patients: insights from the Italian systemic sclerosis progression investigation registry of the Italian Society of Rheumatology

Camilla Teresa Magnanimi¹, Enrico De Lorenzis¹, Gerlando Natalello¹, Fabio Cacciapaglia², Rossella De Angelis³, Edoardo Cipolletta³, Maria Antonietta D'Agostino¹, Veronica Cudullo⁴, Giacomo De Luca⁵, Dilia Giuggioli⁶, Francesca Ingegnoli⁷, Valeria Riccieri⁸, Lorenzo Dagna⁵, Fiorenzo Iannone⁹, Clodoveo Ferri⁶, Marco Matucci Cerinic⁵, Silvia Laura Bosello¹. | ¹Division of Rheumatology and Clinical Immunology, Catholic University of the Sacred Heart, Fondazione Policlinico Univer, Roma, Italy; ²Department of Medicine and Surgery, LUM University Giuseppe De Gennaro Casamassima e Rheumatology Service Miulli Ge, Bari, Italy; ³Rheumatology Unit - Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy; ⁴Department of Rheumatology, Policlinico San Matteo, Pavia, Italy; ⁵Unit of Immunology, Rheumatology, Allergy and Rare Diseases ^UnIRAR, IRCCS San Raffaele Scientific Institute, Vita-Salu, Milano, Italy; ⁶Rheumatology Unit, School of Medicine, University of Modena and Reggio Emilia, Modena, Italy; ⁷Division of Clinical Rheumatology, ASST Pini, Dept. of Clinical Sciences e Community Health, Research Center for Adult a, Milano, Italy; ⁸Department of Rheumatology, La Sapienza University of Rome, Roma, Italy; ⁹Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy.

Background. Commuting poses a considerable burden and costs for patients with rare rheumatic diseases such as systemic sclerosis (SSc), who require care from tertiary medical centres. In a universal healthcare system, the selection of healthcare services is possibly influenced by geographical distribution, referral networks from primary care, and patient preferences. This study aims to evaluate whether longer commuting distances are associated with clinical variables and differences in medication access among Italian SSc patients receiving follow-up care at tertiary centres.

Materials and Methods. The driving distance from the city of residence to the care centre was calculated using the Google Maps Distance Matrix API for anonymized patients with SSc from the Systemic Sclerosis Progression INvestiGation (SPRING) Italian registry. This distance was then correlated with clinical and drug history in an ordinal logistic regression analysis.

Results. The characteristics of 1,782 patients were obtained from 38 centres across the country (Figure 1 and Table 1): 74.2% were categorized as short-distance commuters (traveling less than 100 km), 20.1% as intermediate-distance commuters (traveling 100-500 km), and 5.6% as long-distance commuters (traveling more than 500 km). Notably, 24.6% of the patients received care outside their residential administrative region. Patients with interstitial lung disease (ILD), pulmonary arterial hypertension, lower Forced Vital Capacity (FVC), reduced Diffusion Capacity for Carbon Monoxide (DLCO), anti-Scl70 positivity, and anti-centromere negativity had higher probability of traveling longer distances. Similarly, access to multiple immunosuppressants (cyclophosphamide, azathioprine, methotrexate, tocilizumab) and vasoactive/vasodilator drugs (Endothelin Receptor Antagonists (ERA), Phosphodiesterase Type 5 Inhibitors (PDE5i), iloprost) was associated with increased probability of long travel distances (Table 1). No significant differences were correlated to demographics or comorbidity burden.

Conclusions. SSc patients with pulmonary complications are more likely to undertake longer commuting distances and have a higher likelihood of receiving advanced treatments. Public health strategies should aim to enhance accessibility to specialized care and advanced therapies for these patients, recognizing the impact of travel burden on healthcare access.