Lower socioeconomic status linked with worse outcomes in IBD
Lower socioeconomic status correlated with worse outcomes in patients with inflammatory bowel disease, according to a study published in the American Journal of Gastroenterology.
“Although there is great interest in identifying biological predictors of long-term outcomes such as genes, antibodies or phenotype characteristics, our study shows that social determinants at diagnosis should be highly considered and addressed,” Charles N. Bernstein, MD, from the Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Canada, and colleagues wrote.
Bernstein and colleagues identified 9,298 patients with IBD from the Manitoba Health database. They were able to identify outpatient physician visits, hospitalizations, surgeries, intensive care unit admissions and prescription. The investigators linked data to two databases; one that identified all individuals who received employment and income assistance and all individuals with child and family services contact. They used a factor score that incorporated average household income, single parent households, unemployment rate and high school education rate to define area-level socioeconomic status.
“[Lower socioeconomic status (LSS)] was identified by ever being registered for Employment and Income Assistance or with Child and Family Services or being in the lowest area-level socioeconomic status quintile,” Bernstein and colleagues wrote.
Results showed there were increased rates of annual outpatient physician visits among patients with lower socioeconomic status compared with those without lower socioeconomic status markers (RR = 1.1, 95% CI, 1.06–1.13). Further, patients with lower socioeconomic status had increased rates of hospitalizations (RR = 1.38; 95% CI, 1.31–1.44), intensive care unit admission(RR = 1.94; 95% CI, 1.65–2.27), use of corticosteroids greater than 2,000 mg (RR = 1.12; 95% CI, 1.03–1.21) and death (HR = 1.53; 95% CI, 1.36–1.73).
According to researchers, narcotics (RR = 2.17; 95% CI, 2.01–2.34) and psychotropic medication use (RR = 1.98; 95% CI, 1.84–2.13) were also increased. The effect of lower socioeconomic status was greater in patients with Crohn’s disease compared with those with ulcerative colitis.