Statement of the Problem: Interstitial lung disease (ILD) is an extensive class of heterogeneous lung diseases that consist of more than 130 disorders that are characterized by scarring of the lungs. One study has noted that occurrence of ILD diagnoses increased dramatically with age.1 ILD can be idiopathic in nature, caused by environmental and chemical exposure or can be found in conjunction with systemic conditions to include collagen vascular diseases (CVDs) (i.e. rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and polymyositis/dermatomyositis (PM/DM). The idiopathic ILDs and those secondary to CVDs may be clinically, radiographically, and histologically indistinguishable.2 However, the 5 year-mortality differs between patients with idiopathic pulmonary fibrosis (44%) and those with collagen vascular disease (33%). 3 The progression of these CVDs is not well understood and appears to vary from person to person and by disease. The involvement of lung disease may be one of the first or the last complications a patient might exhibit.4 For example, ILD may precede arthritis in up to 25% of patients with RA and may precede muscle or skin involvement in 33% of patients with PM/DM.2,5 In addition, ILD is now the leading cause of mortality in patients with PM/DM.

Fifteen percent of patients seen by pulmonologists have ILD. Even though, this number clearly indicates that ILD is far from infrequent, epidemiological data on ILD are scarce for the general population.1 It is possible to make some inferences about the prevalence of CVD-ILD based on what is known about the major categories of CVD: SLE, RA and PM/DM.

CVDs do not discriminate among patients and occur in all race, age, and ethnic groups. However, not all ethnic and age populations are equally affected. There are discernible differences in the prevalence, incidence, severity, outcome, and process of care between elderly African Americans (AA) and other racial groups.

Specific Aims: The proposed study will attempt to address the following questions:

1. Would benefits of screening for collagen vascular disease differ between minority and majority elderly interstitial lung disease (ILD) patients?
2. If so, does this difference influence health and economic outcomes between these patients?