Prevalence, Risk Factors, and Outcomes of Adult Interstitial Lung Abnormalities: A Systematic Review and Meta-Analysis.

BACKGROUND: Incidental parenchymal abnormalities detected on chest computed tomography scans are termed interstitial lung abnormalities (ILAs). ILAs may represent early ILD and are associated with increased risk of progressive fibrosis and mortality. The prevalence of ILAs is unknown, with heterogeneity across study populations.

OBJECTIVE: Estimate the pooled prevalence of ILAs in lung cancer screening, general population-based, and at-risk familial cohorts using meta-analysis, identify variables associated with ILA risk, and characterize ILA-associated mortality.

METHODS: The study protocol was registered on PROSPERO (CRD42022373203) and Meta-Analyses of Observational Studies in Epidemiology recommendations followed. Relevant studies were searched on Embase and Medline. Study titles were screened and abstracts reviewed for full-text eligibility. Random effect models were used to pool prevalence estimates for specified sub-groups, and ILA-associated mortality risk. Risk of ILAs was estimated based on age, sex, and forced vital capacity (FVC). Quality assessment was conducted using an adapted Assessment Tool for Prevalence Studies.

RESULTS: The search identified 9536 studies, with 22 included, comprising 88,325 participants. The pooled ILA prevalence was 7% (95%CI 0.01 to 0.13) in lung cancer screening, 7% (95%CI 0.04 to 0.10) in general population, and 26% (95%CI 0.20 to 0.32) in familial cohorts. Pooled mortality risk was increased in those with ILAs (OR=3.56, 95%CI 2.19 to 5.81). Older age, male sex and lower FVC% were associated with greater odds of ILA.

CONCLUSIONS: Populations undergoing imaging for non-ILD indications demonstrate high ILA prevalence. Standardized reporting and follow-up of ILAs is needed, including defining those at greatest risk of progression to ILD.