P0573 - Social Disparities Negatively Impact Outcomes in IBD Patients on Biologic Therapy: A Retrospective Analysis

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Carlos J. Figueredo, MD

Montefiore Medical Center
Yonkers, NY, United States

Carlos J. Figueredo, MD¹, Christopher Andrade, ², Konstantin Boroda, MD³, Tehseen Haider, MD², Tamoor Shahid, MD², Waqas Nawaz, MD⁴, Hilary I. Hertan, MD, FACG²
¹Montefiore Medical Center, Yonkers, NY; ²Montefiore Medical Center, Bronx, NY; ³Digestive Care Center, Evansville, IN; ⁴Ohio State College of Medicine, Columbus, OH

Introduction: Socioeconomic and racial disparities have been previously established as negatively impacting the efficacy and healthcare expenditure in patients with systemic diseases. In the IBD population, studies to date remain limited regarding the identification of other potential key factors affecting differences in outcome. We present a retrospective analysis from 2010 to 2020 looking at the potential impact of racial and sociodemographic (SD) factors in the outcomes of IBD patients on biologic therapy without other pre-existent autoimmune disorders.

Methods: Demographic variables were present in the form of means or proportions. Race, employment status, insurance type, zip code, and language preference (English/Spanish) data were obtained retrospectively by chart review. Further analysis was performed by Multivariate Analysis with Logistic Regression to identify independent variables association. Subgroup analysis was assessed for each outcome (readmission at 1,3, 5 years, infection, mortality, neoplasm) variable using the same method.

Results: 215 patients were included. 62% had Ulcerative colitis and 38% Crohn’s disease. 26% African American (AA); White 27%; Hispanic 27%, with the remaining demographic characteristics presented in Table 1. Clostridium difficile, and skin abscesses (SA) were found to be statistically significantly higher in AA and Whites (p< 0.01). Similarly, SA was found to be significant for those with Medicaid only (p< 0.01). Composite skin reactions were statistically significantly higher in patients located at Manhattan zip codes (p< 0.01). Employed patients with private insurance had a reduction of readmission within 1 year and reduction of a flare event occurring at 1 year after biologics prescription (OR: 0.3718599; CI: .2050538- .6743587); p< 0.05) and (OR: .4140468; CI: .2144398-.7994538; p< 0.01); respectively. The Spanish language was associated with increased readmission at the 1-to-3-year endpoint (OR: 3.550171; CI: 1.005745- 12.53172; p< 0.05).

Discussion: SD factors proved to have a critical role in the outcomes of the involved cohort. Private insurance and employment favorably decrease the need for readmission in these patients. Comparably, SA was higher in those who lack private insurance. Spanish language preference was associated with poor outcomes and may reflect potential communication barriers within the healthcare network. More studies are required to establish an association between higher skin reactions to the patient’s geographic location.

Age		43.92 (mean)
Age subgroup	18-25	11 %
	26-45	47 %
	46-65	30 %
	66-90	12 %

Sex	Female	50.5 %
	Male	49.5 %

Weight		76.88 (mean)
Race	African American	26 %
	White	27 %
	Hispanic	27 %
	Asian	1.5 %
	Unknown	12 %
	Other	6 %
	Native American	0.5 %

IBD type	Ulcerative colitis	62% (N=133)
	Crohn’s disease	38% (N=82)

Smoking status	Active	9 %
	Former	24 %
	Never	67 %

Language preference	English	91 %
	Spanish	8 %
	Other	1 %

Insurance type	Medicaid	30 %
	Private	45 %
	Medicare	16 %
	None	9 %

Location	Bronx	61.5 %
	Yonkers	6 %
	Manhattan	6 %
	Brooklyn	4 %
	Queens	1 %
	White plains	1 %
	New Jersey	2 %
	Other	4.5 %
	Upstate New York other	14 %

Employment status	Unemployed	46 %
	Employed	49 %
	Retired	4 %
	Unknown	1 %

Time from IBD diagnosis		14.92 (mean)
Number of biologics prescribed since diagnosis		1.64 (mean)
Subgroup analysis
Infection (Clostridium difficile)		Odds ratio/Confidence interval (p value)
	Race (African American)	1.82E+07 (155183.8-2.14e+09) (p< 0.01)
	Race (White)	1.82e+07 (155183.8-2.14e+09) (p< 0.01)
Infection (Skin Abscess)		Odds ratio/Confidence interval (p value)
	Race (African American)	413121.5 (17121.87-9967917) (p< 0.01)
	Race (White)	2067665 (210697.5-2.03e+07) (p< 0.01)
	Insurance type/Medicaid	1443319 (43239.06-4.82e+07) (p< 0.01)
Readmission 1 year after start of biologics		Odds ratio/Confidence interval (p value)
	Race	0.9012624 (.6498779-1.249887) (p=0.533)
	Language preference	0.5732252 (.117765-2.790192) (p=0.491)
	Employment status	1.417211 (.6734474-2.982395) (p=0.358)
	Smoking status	1.551002 (.7558761-3.18254) (p=0.231)
	Zipcode	0.9184333 (.7980557-1.056969) (p=0.235)
	Insurance type/Private	0.3718599 (.2050538-.6743587) (p< 0.01)
Readmission causes at 1 year after biologics (flare)		Odds ratio/Confidence interval (p-value)
	Race	0.9984793 (.688729-1.447537) (p= 0.994)
	Language preference	0.9110592 (.179011-4.636748) (p= 0.911)
	Employment status	1.937288 (8359931-4.489375) (p= 0.123)
	Smoking status	1.492651 (.6485559-3.435334) (p= 0.346)
	Zipcode	0.9412791 (.8048391-1.100849) (p= 0.449)
	Insurance type/Private	0.4140468 (.2144398-.7994538) (p< 0.01)
	Insurance type/Medicare	2.559428 (.2384073-27.47682) (p= 0.438)
	Insurance type/Medicaid	3.664664 (.4408618-30.46252) (p= 0.229)
Readmission at 1 to 3 years after biologics		Odds ratio/Confidence interval (p-value)
	Race	0.9380275 (.6655489-1.32206) (p= 0.715)
	Language preference/Spanish	3.550171 (1.005745-12.53172) (p< 0.05)
	Employment status	0.4973359 (.2155696-1.147392) (p= 0.102)
	Smoking status	1.157107 (.5856971-2.285987) (p= 0.674)
	Zipcode/New Jersey	0.736938 (.5484095-.9902776) (p < 0.05)
	Insurance type/Private	0.5572771 (.3179966-.9766072) (p< 0.05)
Readmission causes at 1 to 3 years after biologics (flare)		Odds ratio/Confidence interval (p-value)
	Race	0.7255185 (.4528195-1.162444) (p= 0.182)
	Language preference	2.314757 (.5746962-9.323362) (p= 0.23)
	Employment status	0.6480384 (.2303716-1.822941) (p = 0.411)
	Smoking status	0.9221566 (.4043702-2.102956) (p= 0.847)
	Zipcode	0.8720716 (.6715901-1.1324) (p= 0.304)
	Insurance type	0.6688203 (.3323027-1.346124) (p= 0.26)
Readmission at 3 to 5 years after biologics		Odds ratio/Confidence interval (p-value)
	Race	0.9136679 (.6425724-1.299136) (p= 0.61)
	Language preference	0.6903903 (.1445006-3.298524) (p= 0.64)
	Employment status/unemployed	1.298029 (.5540442-3.041057) (p= 0.54)
	Employment status/employed	0.028917 (.001038-.805569) (p< 0.05)
	Smoking status	0.8798397 (.446633-1.73323) (p= 0.71)
	Zipcode	1.006652 (.8802437-1.151212) (p= 0.92)
	Insurance type	0.8000738 (.4594826-1.393128) (p= 0.43)
Readmission causes at 3 to 5 years after biologics (flare)		Odds ratio/Confidence interval (p-value)
	Race	0.9224976 (.6142888-1.385345) (p= 0.69)
	Language preference	0.8965766 (.1836896-4.376129) (p= 0.089)
	Employment status	2.312571 (.8573128-6.238077) (p= 0.098)
	Smoking status	0.7325968 (.3409321-1.574208) (p= 0.425)
	Zipcode	0.9727514 (.8295088-1.14073) (p= 0.734)
	Insurance type	0.813614 (.4273323-1.54907) (p= 0.53)

Table: Demographic characteristics and subgroup analysis by logistic regression studying the interaction of demographic and socioeconomic variables relationship with readmission and flare as outcomes.

Disclosures:

Carlos Figueredo indicated no relevant financial relationships.

Christopher Andrade indicated no relevant financial relationships.

Konstantin Boroda indicated no relevant financial relationships.

Tehseen Haider indicated no relevant financial relationships.

Tamoor Shahid indicated no relevant financial relationships.

Waqas Nawaz indicated no relevant financial relationships.

Hilary Hertan indicated no relevant financial relationships.

Carlos J. Figueredo, MD¹, Christopher Andrade, ², Konstantin Boroda, MD³, Tehseen Haider, MD², Tamoor Shahid, MD², Waqas Nawaz, MD⁴, Hilary I. Hertan, MD, FACG². P0573 - Social Disparities Negatively Impact Outcomes in IBD Patients on Biologic Therapy: A Retrospective Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.