Socioeconomic status & IBD outcomes

February 9, 2021

Issue 03

Clinical Question

Does lower socioeconomic status worsen IBD outcomes?

Editor’s Bottom Line

Low socio-economic status is associated with worse outcomes of inflammatory bowel disease. Although the reasons for this association need further study, clinicians must ensure all patients receive the best care.

Reference

Bernstein CN, Walld R, Marrie RA. Social Determinants of Outcomes in Inflammatory Bowel Disease. Am J Gastroenterol. 2020;115(12):203646; https://journals.lww.com/ajg/Fulltext/2020/12000/Social_Determinants_of_Outcomes_in_Inflammatory.23.aspx

Synopsis

Researchers examined administrative data from 9,298 residents of Manitoba with IBD enrolled in a provincial database between 1995 and 2018. They compared outcomes of those with higher socioeconomic status (SES) to those with lower SES, defined as receipt of financial assistance, contact with Child and Family Services, or a composite score based on geographically-defined averages of household income, rates of single parent status, unemployment and high school education. 2,905 IBD patients met at least one of the indicators of low SES. Patients in the higher and lower SES groups were similar in terms of duration of disease, type of IBD, urban residence, sex and age.

IBD-specific hospitalization rates were 28% higher for those who met at least one indicator of lower SES, compared to those who did not (Relative Risk [RR]: 1.28; 95% Confidence Interval [CI], 1.31–1.44). Those with lower SES were also more likely to receive high doses of corticosteroids (RR: 1.12; 95% CI, 1.03–1.21) and were nearly twice as likely to have an intensive care unit admission (RR: 1.94; 95% CI, 1.65–2.27). The annual number of outpatient physician visits for any reason was 10% higher with lower SES (RR: 1.10; 95% CI, 1.06–1.13), the risk of all-cause mortality was 53% higher (Hazard Ratio: 1.53; 95% CI, 1.36–1.73), the likelihood of prescribed narcotics use was more than twice as high (RR: 2.17; 95% CI, 2.01–2.34) and use of psychotropic medications was similarly increased (RR: 1.98; 95% CI, 1.84–2.13). SES did not affect use of biologics and the detrimental impact of lower SES was greatest for patients with Crohn’s disease.

Details

Study Design: Population-based administrative health database study

Funding: Guts and Roses

Allocation: Not applicable

Setting: Single center

Level of Evidence: 2c