B0394 - Association Between Severity, Socioeconomic Factors, Patient-Reported Outcomes, and Healthcare Resource Use Across Racial/Ethnic Groups in Inflammatory Bowel Disease: Results From the National Health and Wellness Survey

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

AP

Aarti A. Patel, PharmD, MBA

Janssen Scientific Affairs, LLC
Titusville, NJ

Sabree Burbage, PharmD, MPH¹, Kathryn Krupsky, PhD², M. Janelle Cambron-Mellott, PhD³, Nate Way, PhD³, Aarti A. Patel, PharmD, MBA⁴, Julia Liu, MD, MS⁵
¹Janssen Scientific Affairs, LLC, Horsham, PA; ²Cerner Enviza, North Kansas City, MO; ³Cerner Enviza, Malvern, PA; ⁴Janssen Scientific Affairs, LLC, Titusville, NJ; ⁵Morehouse School of Medicine, Decatur, GA

Introduction: Black, Indigenous, and People of Color (BIPOC) with inflammatory bowel disease (IBD) experience greater socioeconomic disadvantages and often present with more advanced disease than White patients. In this study, we assessed the relationship of race/ethnicity and IBD severity with socioeconomic factors, health‑related quality of life (HRQoL), and healthcare resource use (HCRU) in individuals with IBD.

Methods: Data were obtained for adults self-reporting a physician diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC) from the National Health and Wellness Survey (2018-2020). Bivariate (interim) analyses were conducted to compare socioeconomic factors, HRQoL, HCRU, and costs by IBD severity within racial/ethnic groups.

Results: Analyses included 2,577 participants (CD: 818 White, 109 Black, and 150 Hispanic; UC: 1,150 White, 99 Black, and 251 Hispanic). Black participants with moderate/severe CD had fewer social and financial resources than those with mild CD, including a higher proportion of single (70.7% vs. 58.8%), uninsured (17.2% vs. 11.8%), and low‑household–income (< $25,000/year; 41.4% vs. 15.7%) participants; these factors did not consistently differ by disease severity in White or Hispanic participants with CD. Increased disease severity was associated with worse HRQoL and work productivity across several PROs (PHQ-9, MCS, PCS, SF-6D index, EQ‑5D index, and WPAI; all P≤0.036) and greater HCRU in all participants with UC and in Black and White, but not Hispanic, participants with CD. Although not directly comparable in the bivariate analysis, a higher proportion of Black participants with moderate/severe CD were single (70.7% vs. 33.9%), uninsured (17.2% vs. 8.9%), and had low household income (< $25,000/year; 41.4% vs. 12.8%) than White participants. White participants with moderate/severe UC had lower mean annualized direct medical costs than Black and Hispanic participants ($56,002, $93,298, and $106,693, respectively).

Discussion: Increased disease severity was associated with worse HRQoL and work productivity and higher HCRU in Black and White participants with CD and in all racial/ethnic groups with UC. Negative socioeconomic factors also increased with moderate/severe disease in Black, but not White or Hispanic, participants with CD. These findings suggest a need to better understand associations between race/ethnicity, disease severity, socioeconomic factors, and health outcomes in IBD.

	White		Black		Hispanic
CD	Mild (n = 514)	Moderate/Severe (n = 304)	Mild (n = 51)	Moderate/Severe (n = 58)	Mild (n = 83)	Moderate/Severe (n = 67)
Marital status, n (%) Married/living with a partner Single, not married/divorced/ separated/widowed Decline to answer	317 (61.7%) 196 (38.1%) 1 (0.2%)	201 (66.1%) 103 (33.9%) 0 (0.0%)	21 (41.2%) 30 (58.8%) 0 (0.0%)	16 (27.6%) 41 (70.7%)* 1 (1.7%)	52 (62.7%) 31 (37.3%) 0 (0.0%)	42 (62.7%) 25 (37.3%) 0 (0.0%)
Household income, n (%) < $25,000 $25,000 to < $50,000 $50,000 to < $100,000 $100,000+ Decline to answer	63 (12.3%) 107 (20.8%) 179 (34.8%) 152 (29.6%) 13 (2.5%)	39 (12.8%) 56 (18.4%) 110 (36.2%) 94 (30.9%) 5 (1.6%)	8 (15.7%) 10 (19.6%) 18 (35.3%) 15 (29.4%) 0 (0.0%)	24 (41.4%)* 10 (17.2%) 11 (19.0%) 12 (20.7%) 1 (1.7%)	10 (12.0%) 18 (21.7%) 26 (31.3%) 29 (34.9%) 0 (0.0%)	6 (9.0%) 11 (16.4%) 21 (31.3%) 28 (41.8%) 1 (1.5%)
Health insurance, n (%) Not insured Commercially insured Medicaid Medicare Other type of insurance/unsure	31 (6.0%) 289 (56.2%) 50 (9.7%) 133 (25.9%) 11 (2.1%)	27 (8.9%) 167 (54.9%) 31 (10.2%) 70 (23.0%) 9 (3.0%)	6 (11.8%) 36 (70.6%) 2 (3.9%) 5 (9.8%) 2 (3.9%)	10 (17.2%) 29 (50.0%) 8 (13.8%) 10 (17.2%) 1 (1.7%)	12 (14.5%) 50 (60.2%) 5 (6.0%) 10 (12.0%) 6 (7.2%)	9 (13.4%) 41 (61.2%) 6 (9.0%) 4 (6.0%) 7 (10.4%)
HRQoL, mean (SD) PHQ-9 score^a GAD-7 score^b MCS score^c PCS score^c SF-6D Index score^c EQ-5D Index score^d EQ VAS score	7.36 (6.86) 5.72 (5.87) 43.50 (11.83) 46.08 (9.77) 0.660 (0.147) 0.764 (0.177) 67.60 (23.85)	11.10 (7.70)* 7.94 (6.40)* 38.82 (11.55)* 39.96 (10.02)* 0.579 (0.12)* 0.657 (0.23)* 56.72 (25.33)*	6.71 (5.66) 5.80 (5.37) 43.38 (10.24) 48.53 (8.15) 0.664 (0.136) 0.772 (0.156) 65.84 (27.84)	9.76 (5.40)* 7.45 (4.53) 38.64 (10.85)* 40.32 (8.93)* 0.567 (0.11)* 0.674 (0.17)* 55.88 (31.24)	11.59 (7.57) 8.54 (5.98) 38.54 (9.87) 42.78 (8.39) 0.574 (0.122) 0.651 (0.239) 65.00 (27.03)	13.76 (6.64) 10.67 (5.45)* 34.87 (9.63)* 40.95 (7.80) 0.535 (0.12) 0.600 (0.22) 56.90 (29.32)
HCRU (past 6 months), mean (SD) Total number of HCP visits^e Total number of GE visits Total number of ER visits Total number of hospitalizations	6.53 (7.48) 0.68 (1.09) 0.72 (1.76) 0.49 (1.30)	8.44 (12.87)* 0.90 (1.31)* 1.36 (2.72)* 1.20 (2.74)*	4.12 (3.37) 0.37 (0.75) 0.86 (1.98) 0.59 (1.46)	7.69 (8.65)* 1.31 (2.05)* 1.97 (4.03) 1.40 (2.32)*	7.31 (8.61) 0.34 (0.83) 2.13 (7.39) 1.88 (5.22)	7.69 (8.65)* 1.31 (2.05)* 1.97 (4.03) 1.40 (2.32)*
Costs (USD), mean (SD) Total annualized direct medical costs Total annual indirect costs^f	$41,069 ($59,079) $14,046 ($17,151)	$75,005 ($125,087) $19,247 ($18,573)*	$35,337 ($58,132) $12,554 ($14,177)	$75,679 ($92,124)* $17,562 ($19,416)	$89,906 ($202,298) $18,047 ($17,471)	$75,679 ($92,124)* $17,562 ($19,416)
	White		Black		Hispanic
UC	Mild (n = 789)	Moderate/Severe (n = 361)	Mild (n = 61)	Moderate/Severe (n = 38)	Mild (n = 134)	Moderate/Severe (n = 117)
Marital status, n (%) Married/living with a partner Single, not married/divorced/ separated/widowed Decline to answer	501 (63.5%) 288 (36.5%) 0 (0%)	217 (60.1%) 141 (39.1%) 3 (0.8%)	19 (31.1%) 42 (68.9%) 0 (0.0%)	10 (26.3%) 28 (73.7%) 0 (0.0%)	63 (47.0%) 70 (52.2%) 1 (0.7%)	62 (53.0%) 54 (46.2%) 1 (0.9%)
Household income, n (%) < $25,000 $25,000 to < $50,000 $50,000 to < $100,000 $100,000+ Decline to answer	96 (12.2%) 161 (20.4%) 290 (36.8%) 209 (26.5%) 33 (4.2%)	70 (19.4%)* 74 (20.5%) 119 (33.0%) 90 (24.9%) 8 (2.2%)	11 (18.0%) 13 (21.3%) 21 (34.4%) 16 (26.2%) 0 (0.0%)	11 (28.9%) 12 (31.6%) 8 (21.1%) 7 (18.4%) 0 (0.0%)	17 (12.7%) 35 (26.1%) 36 (26.9%) 39 (29.1%) 7 (5.2%)	22 (18.8%)* 18 (15.4%) 38 (32.5%) 38 (32.5%) 1 (0.9%)
Health insurance, n (%) Not insured Commercially insured Medicaid Medicare Other type of insurance/unsure	44 (5.6%) 417 (52.9%) 40 (5.1%) 267 (33.8%) 21 (2.7%)	44 (12.2%)* 166 (46.0%) 45 (12.5%) 95 (26.3%) 11 (3.0%)	6 (9.8%) 30 (49.2%) 9 (14.8%) 12 (19.7%) 4 (6.6%)	5 (13.2%) 24 (63.2%) 4 (10.5%) 4 (10.5%) 1 (2.6%)	16 (11.9%) 78 (58.2%) 12 (9.0%) 19 (14.2%) 9 (6.7%)	21 (17.9%) 71 (60.7%) 9 (7.7%) 8 (6.8%) 8 (6.8%)
HRQoL, mean (SD) PHQ-9 score^a GAD-7 score^b MCS score^c PCS score^c SF-6D Index score^c EQ-5D Index score^d EQ VAS score	6.41 (6.62) 4.73 (5.26) 45.74 (11.86) 46.05 (10.16) 0.674 (0.139) 0.766 (0.174) 67.37 (25.43)	9.90 (7.28)* 7.42 (5.83)* 39.16 (11.85)* 40.97 (9.81)* 0.588 (0.128)* 0.679 (0.196)* 57.99 (25.81)*	7.18 (6.58) 5.15 (4.83) 45.43 (11.59) 46.01 (9.19) 0.666 (0.164) 0.786 (0.140) 71.56 (24.91)	10.79 (6.35)* 8.74 (5.10)* 36.39 (7.21)* 42.35 (6.72)* 0.541 (0.104)* 0.685 (0.169)* 61.63 (32.96)*	8.81 (6.96) 7.10 (5.45) 41.05 (10.31) 45.73 (8.93) 0.619 (0.131) 0.714 (0.185) 67.33 (24.74)	12.76 (7.08)* 9.69 (5.18)* 36.03 (8.79)* 41.31 (8.30)* 0.548 (0.109)* 0.619 (0.217)* 59.61 (29.24)*
HCRU (past 6 months), mean (SD) Total number of HCP visits^e Total number of GE visits Total number of ER visits Total number of hospitalizations	5.83 (6.23) 0.47 (0.86) 0.50 (1.81) 0.48 (3.16)	23.11 (26.85)* 50.27 (31.32)* 56.18 (33.83)* 53.60 (29.31)	7.80 (10.43) 0.39 (0.69) 1.10 (2.11) 0.98 (1.86)	6.55 (6.02) 0.45 (1.03) 2.00 (2.72) 2.08 (2.81)*	7.59 (15.44) 0.70 (1.71) 1.13 (3.04) 1.73 (7.36)	13.93 (42.93) 1.56 (6.59) 2.84 (5.08)* 1.80 (2.51)
Costs (USD), mean (SD) Total annualized direct medical costs Total annual indirect costs^f	$41,016 ($152,411) $11,602 ($17,080)	$56,002 ($136,303) $20,076 ($20,522)*	$62,168 ($80,425) $11,780 ($15,597)	$93,298 ($103,897) $14,223 ($17,819)	$84,639 ($250,376) $15,620 ($16,305)	$106,693 ($165,679) $18,644 ($16,441)

Table: Sociodemographic characteristics, HRQoL, HCRU, and costs in White, Black, and Hispanic participants with IBD by disease severity.
a PHQ-9 includes nine items (range of 0 to 27) where higher scores indicate mores severe depression.
b GAD-7 includes seven items (range 0 to 21) and a higher score indicates more severe general anxiety disorder.
c Differences in 3 points on the norm-based component summary scores and 0.041 points on health utilities represent clinically meaningful differences.
d The minimally important difference for this measure is considered to be approximately 0.074 points.
e Includes visits to any of the following: general practitioner/family practitioner; internist; allergist; cardiologist; dentist; dermatologist; diabetologist; endocrinologist; gastroenterologist; geriatrician; gynecologist; hepatologist; infectious disease specialist/infectologist (diseases such as HIV or hepatitis); neurologist; nephrologist; nurse practitioner/physician assistant; obstetrician; oncologist; ophthalmologist; orthopedist; otolaryngologist (ears, nose, and throat specialist); plastic surgeon; podiatrist; psychiatrist; psychologist/therapist; pulmonologist (lung specialist); respiratory therapist; rheumatologist; urologist; other medical specialist.
f Indirect costs were only calculated among respondents who were participating in the labor force at the time of the survey and who had a valid response (i.e., non-missing) for the number of hours working in the past 7 days and the number of hours missed in the past 7 days.
* P < 0.05 between mild and moderate/severe disease within the same racial/ethnic group.
Note: P values were calculated using Bonferroni-adjusted pairwise comparisons.
Abbreviations: BMI = body mass index; CCI = Charlson comorbidity index; CD = Crohn’s disease; EQ = EuroQoL; GAD = general anxiety disorder; GAD = general anxiety disorder; HRCU = healthcare resource utilization; HRQoL = health-related quality of life; MCS = mental component summary; PCS = physical component summary; PHQ = patient health questionnaire; SD = standard deviation; SF = short form; UC = ulcerative colitis; USD = United States dollar; VAS = visual analogue scale.

Disclosures:

Sabree Burbage: Janssen Scientific Affairs – Employee, Stock-privately held company.

Kathryn Krupsky: Janssen – Employee of Cerner Enviza, who received funding to conduct this study.

M. Janelle Cambron-Mellott: Janssen – Employee of Cerner Enviza, who received funding to conduct this study.

Nate Way: Janssen Scientific Affairs – mployee of Cerner Enviza, who received funding to conduct this study.

Aarti Patel: Janssen Scientific Affairs, LLC – Employee, Stock-publicly held company(excluding mutual/index funds).

Julia Liu indicated no relevant financial relationships.

Sabree Burbage, PharmD, MPH¹, Kathryn Krupsky, PhD², M. Janelle Cambron-Mellott, PhD³, Nate Way, PhD³, Aarti A. Patel, PharmD, MBA⁴, Julia Liu, MD, MS⁵. B0394 - Association Between Severity, Socioeconomic Factors, Patient-Reported Outcomes, and Healthcare Resource Use Across Racial/Ethnic Groups in Inflammatory Bowel Disease: Results From the National Health and Wellness Survey, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.