P1582 - Assessing the Impact of COVID-19 on IBD Outcomes Among Vulnerable Patient Populations in a Large Metropolitan Center

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Florence-Damilola Odufalu, MD

University of California San Francisco Center for Colitis and Crohn’s Disease
Los Angeles, CA, United States

Florence-Damilola Odufalu, MD¹, Justin Sewell, MD, PhD, MPH², Uma Mahadevan, MD³
¹University of California San Francisco Center for Colitis and Crohn’s Disease, Los Angeles, CA; ²University of California San Francisco, San Francisco, CA; ³University of California San Francisco Center for Colitis and Crohn’s Disease, San Francisco, CA

Introduction: The COVID-19 pandemic was an unprecedented period, with rapid changes in healthcare delivery as remote access became the norm. The aim of this study was to determine how changes in healthcare delivery during the COVID-19 pandemic impacted disease outcomes in vulnerable patients with IBD.

Methods: Using an observational design, patients with IBD care at the Colitis and Crohn’s Disease Center at UCSF and the Gastroenterology Division at Zuckerberg San Francisco General Hospital (ZSFG) were included. Prospective data on demographics, disease history, and healthcare utilization were acquired at the onset of the COVID-19 pandemic in the United States between March 2020 and December 2020 and compared to healthcare utilization in the previous year.

Results: A total of 1449 patients were enrolled, 1324 at UCSF and 125 at ZSFG, respectively. There were 735 (50.7%) female participants. IBD type included 529 (36.5%) UC, 729 (50.3%) CD and 196 (13.5%) IBD indeterminate. There were fewer IBD-related ED visits, hospitalizations and clinic/telehealth visits at both sites during the COVID-19 era. Compared to the pre-COVID era, patients with UC had a higher percentage of IBD-related ED visits (UCSF 48%, ZSFG 87.5%, p=0.07). Race/ethnicity and language did not significantly impact healthcare utilization. Employment status and insurance significantly impacted IBD-related ED utilization (Table 1A) and hospitalizations (Table 1B). During the COVID era, there was a shift in ED utilization at ZSFG with a reduction in unemployed patients and an increase in employed patients (p=0.05). Similarly, there was a reduction in patients with city sponsored insurance plans with IBD-related ED visits during the COVID era (p=0.01). The number of IBD-related surgeries were unchanged, p=0.72. However, a decrease in IBD-related endoscopy was observed at both sites.

Discussion: This observational study of IBD patients highlighted decreased healthcare utilization during the COVID-19 pandemic, with less IBD-related ED visits and hospitalizations. Although healthcare utilization can be a surrogate marker of IBD activity, COVID-19 was a unique period with limited resources. IBD patients that were underinsured, unemployed, disabled or retired had a higher percentage of ED visits and hospitalizations with the onset of COVID-19. This data provides an intervenable prognostic factor to identify patients at risk for poor outcomes and worsened disease activity when healthcare access is limited.

(A) IBD-Related ED Visits
	Pre-Covid Era (UCSF)	Pre-Covid Era (ZSFG)	COVID-Era (UCSF)	COVID Era (ZSFG	P Value
Employment Status
Employed Unemployed Student Disabled Retired Unknown/Decline Other	79 (51.3%) 25 (16.2%%) 21 (13.6%) 12 (7.8%) 15 (9.7%) 2 (1.3%) 0 (0%)	7 (29.1%) 12 (50%) 0 (0%) 1 (4.1%) 1 (4.1%) 1 (4.1%) 2 (8.3%)	22 (44%) 8 (16%) 7 (14%) 5 (10%) 8 (16%) 0 (0%) 0 (0%)	5 (62.5%) 2 (25%) 0 (0%) 1 (12.5%) 0 (0%) 0 (0%) 0 (0%)	0.0536
Insurance
Medi-CAL Medicare Covered CA (ACA) Healthy SF Private Uninsured/Self-Pay NULL Military Unknown	1 (0.65%) 33 (21.4%) 20 (12.99%) 17 (11.04%) 52 (33.8%) 0 (0%) 30 (19.5%) 1 (0.65%) 0 (0%)	1 (4.1%) 1 (4.1%) 0 (0%) 21 (87.5%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (4.1%)	4 (8%) 16 (32%) 1 (2%) 1 (2%) 20 (40%) 0 (0%) 8 (16%) 0 (0%) 0 (0%)	0 (0%) 0 (0%) 0 (0%) 2 (25%) 0 (0%) 0 (0%) 5 (62%) 0 (0%) 1 (12.5%)	0.0153
(B) IBD-Related Hospitalizations
Employment Status
Employed Unemployed Military Student Disabled Retired Unknown/Decline Other	807 (57.8%) 214 (15.3%) 6 (0.43%) 71 (5.1%) 35 (2.51%) 168 (12.03%) 95 (6.8%) 0 (0%)	4 (15.4%) 1 (3.9%) 0 (0%) 0 (0%) 2 (7.7%) 4 (15.4%) 15 (57.7%) 0 (0%)	19 (39.6%) 21 (43.8%) 0 (0%) 1 (2.1%) 1 (2.1%) 5 (10.4%) 1 (2.1%) 0 (0%)	0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 (25%) 1 (25%) 2 (50%) 0 (0%)	0.0347
Insurance
Medi-CAL Medicare Covered CA (ACA) Healthy SF Private Uninsured/Self-Pay NULL Military Unknown	68 (4.9%) 186 (13.3%) 11 (0.8%) 0 (0%) 565 (40.5%) 0 (0%) 566 (40.5%) 0 (0%) 0 (0%)	0 (0%) 4 (15.4%) 0 (0%) 21 (80.8%) 0 (0%) 0 (0%) 1 (3.9%) 0 (0%) 0 (0%)	5 (10.4%) 1 (2.1%) 1 (2.1%) 0 (0%) 13 (27.1%) 0 (0%) 28 (58.3%) 0 (0%) 0 (0%)	0 (0%) 0 (0%) 0 (0%) 4 (100%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)	0.0256

Table: Table 1. Healthcare Utilization by Employment Status and Insurance
(UCSF) Colitis and Crohn’s Disease Center at University of California San Francisco
(ZSFG) Zuckerberg San Francisco General Hospital and Trauma Center
(ACA) Affordable Care Act

Disclosures:
Florence-Damilola Odufalu indicated no relevant financial relationships.
Justin Sewell indicated no relevant financial relationships.
Uma Mahadevan: AbbVie – Consultant. Janssen – Consultant. Pfizer – Consultant. Takeda – Consultant.

Florence-Damilola Odufalu, MD¹, Justin Sewell, MD, PhD, MPH², Uma Mahadevan, MD³. P1582 - Assessing the Impact of COVID-19 on IBD Outcomes Among Vulnerable Patient Populations in a Large Metropolitan Center, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.