Thomas Jefferson University Hospital Philadelphia, PA
Brenda French, MD1, Christine Shieh, MD1, Caroline Johnson, MD2; 1Thomas Jefferson University Hospital, Philadelphia, PA; 2Philadelphia Department of Public Health, Philadelphia, PA
Introduction: Diverticular disease is responsible for a significant portion of annual hospital admissions and healthcare spending. The precursor to developing symptomatic diverticular disease is diverticulosis, which can be asymptomatic and difficult to track epidemiologically. As diet and lifestyle choices have been implicated in development of diverticulosis, we sought to examine the association between income and diverticular disease prevalence since income can determine access to factors such as healthier foods that may protect against diverticulosis. Methods: Prevalence of diverticular disease admissions from 2002 to 2018 was tabulated for each zip code in Philadelphia using inpatient data from the Pennsylvania Health Care Cost Containment Council (PHC4). Additionally, public data available from the IRS was used to determine average household income and mean age for Philadelphia residents by zip code. Multiple linear regression was used to determine association between prevalence of diverticular disease hospitalizations and average household income of each zip code. Results: A comparison of the percentage of residents for each Philadelphia zip code hospitalized with diverticular disease from 2002 to 2018 and the average household income of each zip code demonstrates a strong negative correlation between income and risk of hospitalization with diverticular disease (p< 0.05), after controlling for age. There is a projected 0.06% decrease in affected population of a zip code for every $10,000 increase in average resident’s income starting at 2.25% for $0 income (Figure 1). Discussion: The results of this study support the idea that socioeconomic disparity is closely tied to healthcare disparities in the setting of diverticular disease. Comparing the Philadelphia zip codes with the highest prevalence of admissions for diverticular disease with supermarket proximity, there is a distinct overlap between regions where a higher proportion of residents have “no access” or “low access” to fresh groceries (i.e. food deserts) with the regions where diverticular disease is more prevalent (Figure 2). If diet is a strong predictor of development of diverticular disease, the socioeconomic disparities tied to these vulnerable groups may produce poor access to healthier food options that put them at greater risk for this disease and subsequent complications that require hospitalization.
Ref 1. Walkable Access to Healthy Food in Philadelphia, 2010-2012 Report. Philadelphia Department of Public Health. Mar 2013:10.
Figure 1. Percentage of each Philadelphia zipcode population hospitalized with diverticular disease from 2002 to 2018 compared to the average annual household income of the zipcode, controlling for age.
Figure 2. Comparison of fresh food access for residents of Philadelphia in 2010 (a)(Ref. 1) and prevalence of diverticular disease by Philadelphia zip code from 2002 to 2018 (b).
Disclosures: Brenda French indicated no relevant financial relationships. Christine Shieh indicated no relevant financial relationships. Caroline Johnson indicated no relevant financial relationships.