Travel distance to tertiary healthcare reflects disease severity and medication access in Italian Systemic Sclerosis patients: a geographical study on adult-onset rare diseases

Travel distance to tertiary healthcare reflects disease severity and medication access in Italian Systemic Sclerosis patients: a geographical study on adult-onset rare diseases | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Travel distance to tertiary healthcare reflects disease severity and medication access in Italian Systemic Sclerosis patients: a geographical study on adult-onset rare diseases Enrico Lorenzis, Gerlando Natalello, Rossella Angelis, Lucrezia Verardi, and 73 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8874627/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Systemic sclerosis (SSc) is a rare, multiorgan disease in adults that requires specialized care. Commuting to tertiary medical centers poses a considerable burden and incurs significant costs, potentially affecting management choices. This study aims to describe the healthcare commuting burden and evaluate whether longer commuting distances are associated with disease severity and differences in medication access among Italian SSc patients. Methods The driving distance from the city of residence to the care center was calculated using the Google Maps Distance Matrix API for patients from the Systemic Sclerosis Progression Investigation (SPRING) registry. These distances were categorized according to EUROSTAT classes. Travel distance was then correlated with clinical variables, medication access, and estimated annual pharmaceutical costs, based on standard doses and fares from the Italian Medicines Agency. Results The median commuting distance of the 1,795 enrolled patients was 59·4 (IQR 38·2-101·9) km, with 25·7% of them traveling more than 100 km to reach the tertiary center. Patients commuting more than 100 km to reach a tertiary center presented more frequent and severe vascular and fibrotic pulmonary complications and more commonly accessed advanced medications. The median annual drug cost was €4,407/patient, with 6·2% of patients accounting for half of the total medication budget. Drug costs reflect clinical manifestations, but correlated with commuting distances independently of disease severity. Conclusion Commuting distances are correlated with disease severity and the need for 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. Systemic sclerosis geographical disparities healthcare commuters pharmaceutical costs adult rare diseases Full Text Additional Declarations Table 1 and 2 are available in the Supplementary Files section. Competing interest reported. EDL: none; GN: none; RDA: none; LV: none; DG: none; GBaj: none; LD: none; SBR: none; GZ: lecture honoraria from AstraZeneca; support for attending meetings from Boehringer Ingelheim; RF: none; FCa: consulting fees from Boehringer Ingelheim, MSD, and Johnson & Johnson; advisory board participation for Johnson & Johnson; speaking fees from Boehringer Ingelheim and Johnson & Johnson; GCu: none; AA: none; ER: none; GL: none; FG: none; VR: none; EZ: none; IC: none; FI: none; MDS: none; GM: none; GAb: none; GPet: none; ADR: none; MC: none; AI: none; GCi: none; LB: none; GBag: none; EL: none; MIDA: none; AG: none; CB: research grants from Novartis, EMDO Foundation, Iten-Kohaut Foundation, Wellcome Trust, Kurt und Senta Herrmann Foundation, and the Jubiläum Foundation of Swiss Life; consulting fees from Boehringer Ingelheim and GlaxoSmithKline; support for attending meetings from Boehringer Ingelheim and the Kartmann-Müller Foundation; MO: none; MF: lecture honoraria from Galapagos, Lilly, and Boehringer Ingelheim; MS: none; CA: none; GAl: none; MDB: none; EC: grants from the Foundation for Research in Rheumatology and EULAR; consulting fees from Horizon Therapeutics; lecture fees from IBSA and Novartis; support for attending meetings from Novartis, Lilly, and EULAR; FL: none; AS: none; LM: none; CC: none; GDL: consulting fees from Novartis, SOBI, MSD, Janssen, and Boehringer Ingelheim; VC: none; EV: none; CI: none; GPel: lecture honoraria from AbbVie; support for attending meetings from Alfasigma; EP: none; MGL: none; FFr: none; EG: none; SB: none; GPM: none; FFu: none; LV: none; SP: none; CLP: none; GBi: none; EF: none; GDB: none; MG: none; SDA: none; SG: none; FCoz: none; FCon : none; SG: none; AD: none; CS: none; FI: none; MADA: grants from AbbVie, Amgen, BMS, Lilly, Janssen, Novartis, Galapagos, Pfizer, and MSD; consulting fees from AbbVie, Amgen, BMS, Lilly, Janssen, Novartis, Galapagos, Pfizer, and MSD; lecture honoraria from AbbVie, Amgen, BMS, Lilly, Janssen, Novartis, Galapagos, Pfizer, and MSD; payment for expert testimony from AbbVie, Amgen, BMS, Lilly, Janssen, Novartis, Galapagos, Pfizer, and MSD; support for attending meetings from AbbVie, Amgen, BMS, Lilly, Janssen, Novartis, Galapagos, Pfizer, and MSD; advisory board participation for AbbVie, Amgen, BMS, Lilly, Janssen, Novartis, Galapagos, Pfizer, and MSD; fiduciary roles in APACHE, EULAR, EMA, ISEMIR, OMERACT, DESIR, and GRAPPA; CF: none; MMC: none; SLB: none. Supplementary Files DeLorenzisTable1.docx DeLorenzisTable2.docx DeLorenzisSupplementarymaterial.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 16 Apr, 2026 Reviews received at journal 06 Apr, 2026 Reviews received at journal 29 Mar, 2026 Reviewers agreed at journal 25 Mar, 2026 Reviewers agreed at journal 19 Mar, 2026 Reviewers agreed at journal 18 Mar, 2026 Reviewers invited by journal 17 Mar, 2026 Editor invited by journal 20 Feb, 2026 Editor assigned by journal 18 Feb, 2026 Submission checks completed at journal 18 Feb, 2026 First submitted to journal 13 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8874627","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":608091701,"identity":"7f7a4bde-cf0c-4709-9da3-ea6265a27512","order_by":0,"name":"Enrico Lorenzis","email":"","orcid":"","institution":"Fondazione Policlinico Universitario A. 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EDL: none; GN: none; RDA: none; LV: none; DG: none; GBaj: none; LD: none; SBR: none; GZ: lecture honoraria from AstraZeneca; support for attending meetings from Boehringer Ingelheim; RF: none; FCa: consulting fees from Boehringer Ingelheim, MSD, and Johnson \u0026amp; Johnson; advisory board participation for Johnson \u0026amp; Johnson; speaking fees from Boehringer Ingelheim and Johnson \u0026amp; Johnson; GCu: none; AA: none; ER: none; GL: none; FG: none; VR: none; EZ: none; IC: none; FI: none; MDS: none; GM: none; GAb: none; GPet: none; ADR: none; MC: none; AI: none; GCi: none; LB: none; GBag: none; EL: none; MIDA: none; AG: none; CB: research grants from Novartis, EMDO Foundation, Iten-Kohaut Foundation, Wellcome Trust, Kurt und Senta Herrmann Foundation, and the Jubiläum Foundation of Swiss Life; consulting fees from Boehringer Ingelheim and GlaxoSmithKline; support for attending meetings from Boehringer Ingelheim and the Kartmann-Müller Foundation; MO: none; MF: lecture honoraria from Galapagos, Lilly, and Boehringer Ingelheim; MS: none; CA: none; GAl: none; MDB: none; EC: grants from the Foundation for Research in Rheumatology and EULAR; consulting fees from Horizon Therapeutics; lecture fees from IBSA and Novartis; support for attending meetings from Novartis, Lilly, and EULAR; FL: none; AS: none; LM: none; CC: none; GDL: consulting fees from Novartis, SOBI, MSD, Janssen, and Boehringer Ingelheim; VC: none; EV: none; CI: none; GPel: lecture honoraria from AbbVie; support for attending meetings from Alfasigma; EP: none; MGL: none; FFr: none; EG: none; SB: none; GPM: none; FFu: none; LV: none; SP: none; CLP: none; GBi: none; EF: none; GDB: none; MG: none; SDA: none; SG: none; FCoz: none; FCon : none; SG: none; AD: none; CS: none; FI: none; MADA: grants from AbbVie, Amgen, BMS, Lilly, Janssen, Novartis, Galapagos, Pfizer, and MSD; consulting fees from AbbVie, Amgen, BMS, Lilly, Janssen, Novartis, Galapagos, Pfizer, and MSD; lecture honoraria from AbbVie, Amgen, BMS, Lilly, Janssen, Novartis, Galapagos, Pfizer, and MSD; payment for expert testimony from AbbVie, Amgen, BMS, Lilly, Janssen, Novartis, Galapagos, Pfizer, and MSD; support for attending meetings from AbbVie, Amgen, BMS, Lilly, Janssen, Novartis, Galapagos, Pfizer, and MSD; advisory board participation for AbbVie, Amgen, BMS, Lilly, Janssen, Novartis, Galapagos, Pfizer, and MSD; fiduciary roles in APACHE, EULAR, EMA, ISEMIR, OMERACT, DESIR, and GRAPPA; CF: none; MMC: none; SLB: none.\u003c/p\u003e","formattedTitle":"Travel distance to tertiary healthcare reflects disease severity and medication access in Italian Systemic Sclerosis patients: a geographical study on adult-onset rare diseases","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Systemic sclerosis, geographical disparities, healthcare commuters, pharmaceutical costs, adult rare diseases","lastPublishedDoi":"10.21203/rs.3.rs-8874627/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8874627/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSystemic sclerosis (SSc) is a rare, multiorgan disease in adults that requires specialized care. Commuting to tertiary medical centers poses a considerable burden and incurs significant costs, potentially affecting management choices. This study aims to describe the healthcare commuting burden and evaluate whether longer commuting distances are associated with disease severity and differences in medication access among Italian SSc patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe driving distance from the city of residence to the care center was calculated using the Google Maps Distance Matrix API for patients from the Systemic Sclerosis Progression Investigation (SPRING) registry. These distances were categorized according to EUROSTAT classes. Travel distance was then correlated with clinical variables, medication access, and estimated annual pharmaceutical costs, based on standard doses and fares from the Italian Medicines Agency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe median commuting distance of the 1,795 enrolled patients was 59·4 (IQR 38·2-101·9) km, with 25·7% of them traveling more than 100 km to reach the tertiary center. Patients commuting more than 100 km to reach a tertiary center presented more frequent and severe vascular and fibrotic pulmonary complications and more commonly accessed advanced medications. The median annual drug cost was €4,407/patient, with 6·2% of patients accounting for half of the total medication budget. Drug costs reflect clinical manifestations, but correlated with commuting distances independently of disease severity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCommuting distances are correlated with disease severity and the need for 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.\u003c/p\u003e","manuscriptTitle":"Travel distance to tertiary healthcare reflects disease severity and medication access in Italian Systemic Sclerosis patients: a geographical study on adult-onset rare diseases","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-19 18:22:08","doi":"10.21203/rs.3.rs-8874627/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-16T06:43:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-06T08:04:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-29T21:00:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"138984680919203686038661918884675157861","date":"2026-03-25T08:48:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31442818484371730518603813996786396986","date":"2026-03-19T20:22:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158913167532258309165470723889478508382","date":"2026-03-18T08:03:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-17T09:32:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-20T10:39:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-19T04:45:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-19T04:43:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-02-13T17:57:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eafa1518-72e1-405d-ab06-dbf8f5864ce4","owner":[],"postedDate":"March 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-09T07:11:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-19 18:22:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8874627","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8874627","identity":"rs-8874627","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}