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Background and aim <p>Interstitial Lung Diseases (ILDs) comprise a group of complex disorders characterized by pulmonary inflammation and fibrosis. ILDs represent a challenge in Latin America, yet nationwide longitudinal data remains fragmented. In Ecuador, the clinical landscape of ILD has been shaped by evolving diagnostic capabilities and systemic disruptions caused by recent public health emergencies. We investigated the decade-long evolution of ILD hospitalizations and mortality in Ecuador, examining how diagnostic precision—or the lack thereof—shapes patient survival.</p> Methods <p>We retrospectively analyzed 10,458 hospital discharges from 2015 to 2024 using the National Institute of Statistics and Censuses database. Cases were classified using ICD-10 codes: J84.1 (fibrosis), J84.8 (other specified), and J84.9 (unspecified). Age-standardized hospitalization and mortality rates were calculated. Multivariable logistic regression was utilized to identify independent predictors of in-hospital death, adjusting for sociodemographic factors, institutional settings, and ICD-10 classifications.</p> Results <p>Analysis revealed a mean age-adjusted hospitalization rate of 6.16 per 100,000 inhabitants. Hospitalization rates exhibited a “U-shaped” trajectory, plummeting during the 2020 pandemic shock (3.52 per 100,000) before rebounding in 2022 (7.08 per 100,000). While population-wide mortality stabilized post-pandemic, individual risk of death per admission was statistically associated with temporal variations during 2022–2023 (aOR: 1.797; <i>p</i> = 0.001). Crucially, diagnostic ambiguity was independently associated with a higher likelihood of in-hospital mortality: patients coded as “unspecified” (J84.9) or “other specified” (J84.8) ILD faced significantly higher odds of death (aOR: 1.26 and 1.56, respectively) compared to those with established fibrosis. Furthermore, 27.2% of fatalities occurred within 72&#xa0;h of admission, highlighting severe barriers to timely intervention. Rural mortality (7.6%) significantly exceeded urban mortality (4.3%). Multivariable analysis identified J84.8 (aOR: 1.558) and J84.9 (aOR: 1.263) as independent predictors of higher mortality compared to J84.1. Furthermore, diagnostic coding has diversified, with “unspecified” (J84.9) cases tripling by 2024, particularly in the public sector and younger cohorts.</p> Conclusions <p>The structural shift toward unspecified coding in the post-pandemic era reflects a critical diagnostic gap. In-hospital survival within the Ecuadorian administrative context is strongly associated with specialized clinical coding subcategories and the timing of the hospital course, rather than baseline patient demographics.</p>

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Diagnostic ambiguity and in-hospital mortality determinants: a decadal analysis of interstitial lung disease hospitalization trends in Ecuador (2015–2024)

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  • 发表日期：

    2026年7月31日

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  • Karime Montes-Escobar,
  • Cristian Cornejo Gaete,
  • Carlos A. Salas-Macias,
  • Gustavo I. Rivas-Martínez,
  • Santiago J. Ballaz

摘要

Background and aim

Interstitial Lung Diseases (ILDs) comprise a group of complex disorders characterized by pulmonary inflammation and fibrosis. ILDs represent a challenge in Latin America, yet nationwide longitudinal data remains fragmented. In Ecuador, the clinical landscape of ILD has been shaped by evolving diagnostic capabilities and systemic disruptions caused by recent public health emergencies. We investigated the decade-long evolution of ILD hospitalizations and mortality in Ecuador, examining how diagnostic precision—or the lack thereof—shapes patient survival.

Methods

We retrospectively analyzed 10,458 hospital discharges from 2015 to 2024 using the National Institute of Statistics and Censuses database. Cases were classified using ICD-10 codes: J84.1 (fibrosis), J84.8 (other specified), and J84.9 (unspecified). Age-standardized hospitalization and mortality rates were calculated. Multivariable logistic regression was utilized to identify independent predictors of in-hospital death, adjusting for sociodemographic factors, institutional settings, and ICD-10 classifications.

Results

Analysis revealed a mean age-adjusted hospitalization rate of 6.16 per 100,000 inhabitants. Hospitalization rates exhibited a “U-shaped” trajectory, plummeting during the 2020 pandemic shock (3.52 per 100,000) before rebounding in 2022 (7.08 per 100,000). While population-wide mortality stabilized post-pandemic, individual risk of death per admission was statistically associated with temporal variations during 2022–2023 (aOR: 1.797; p = 0.001). Crucially, diagnostic ambiguity was independently associated with a higher likelihood of in-hospital mortality: patients coded as “unspecified” (J84.9) or “other specified” (J84.8) ILD faced significantly higher odds of death (aOR: 1.26 and 1.56, respectively) compared to those with established fibrosis. Furthermore, 27.2% of fatalities occurred within 72 h of admission, highlighting severe barriers to timely intervention. Rural mortality (7.6%) significantly exceeded urban mortality (4.3%). Multivariable analysis identified J84.8 (aOR: 1.558) and J84.9 (aOR: 1.263) as independent predictors of higher mortality compared to J84.1. Furthermore, diagnostic coding has diversified, with “unspecified” (J84.9) cases tripling by 2024, particularly in the public sector and younger cohorts.

Conclusions

The structural shift toward unspecified coding in the post-pandemic era reflects a critical diagnostic gap. In-hospital survival within the Ecuadorian administrative context is strongly associated with specialized clinical coding subcategories and the timing of the hospital course, rather than baseline patient demographics.