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Monday Poster Session

Category: IBD

P1606 - Sex Differences in Outcomes of Inflammatory Bowel Disease (IBD) Hospitalizations: A Retrospective Cohort Study

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Jennifer Chiagoziem Asotibe, MD

John H. Stroger, Jr. Hospital of Cook County
Chicago, IL, United States

Jennifer Asotibe, MD, Iriagbonse Asemota, MD, Katayoun Khoshbin, MD, Hassam Shah, MD, Marcelo Ramirez, MD, Syed Ali Amir Sherazi, MD, Garima Pudasaini, MD, Niveda Shekar, MD, Attar Bashar, MD
John H. Stroger, Jr. Hospital of Cook County, Chicago, IL

Introduction: Multiple studies have assessed differences amongst male and female patients with IBD in regards to intestinal and extra-intestinal manifestations, choice of treatment, and disease outcome. However, there is no consensus on how gender affects hospitalization outcomes. In this retrospective study, we aim to evaluate the differences in outcomes between males and females hospitalized with a primary diagnosis of IBD.

Methods: Our data was obtained from the 2016 and 2017 National Inpatient Sample (NIS) database. Our primary outcome was inpatient mortality while secondary outcomes were length of stay (LOS), total hospital charges (THC), red blood cell (RBC) transfusion requirement, odds of developing bowel perforation and severe sepsis with septic shock. Multivariate and univariate regression analysis was used accordingly to adjust for confounders.

Results: There were over 71 million discharges in the combined 2016 and 2017 NIS database. We found a total of 177,574 adults with a principal diagnosis of IBD (83729 males, 93749 females). Male IBD patients were found to have higher odds of developing bowel perforation ( 1.4% vs 1.0%, aOR= 0.69, p< 0.0001, CI= 0.565-0.834) when admitted with a principal diagnosis of IBD compared to females. Female IBD patients were however, found to have a 0.32 day decrease in LOS (p < 0.001, CI= -0.444- -0.207) and decrease in mean THC ($43,013 vs $45,575, p < 0.0001, CI= -5618. 55- -2752.89) compared to male patients.

Both groups of patients were found to have similar odds of inpatient mortality, developing severe sepsis with shock and requiring RBC transfusions.

Discussion: The gender differences in outcome measures in our study of hospitalized IBD patients may be explained by various hypotheses: difference in disease course or severity, treatment options or ability to access health care. Additionally, some studies suggested that male patients opted for biologics and reported more extra-intestinal manifestations than females with Crohn’s disease. Male sex has also been linked to worse bowel disease presentation, ileal disease location, increased risk of smoking and bowel surgeries in IBD patients. This may explain the higher odds of bowel perforation observed in our male cohort. Hormonal, genetic, and epigenetic factors may have a role as well. Our study adds new information to the literature. Nonetheless, it is imperative for prospective studies to further elucidate gender differences in the outcome of hospitalized IBD patients.

IBD(n=177,574)

Male(n=83,729)

Female(n=93,749)

P value

Mean age (years)

43.1

45.7

< 0.0001

Race

< 0.0001

White

72.9%

73.5%

Black

13.9%

15.0%

Hispanic

8.4%

7.4%

Asians

1.6%

1.2%

Native Americans

0.4%

Others

2.9%

2.5%

Charlson comorbidity index

< 0.0001

70.5%

66.9%

16.7%

20.1%

6.2%

7.2%

≥3

6.5%

5.8%

Hospital bed size

0.04

Small

18.3%

18.6%

Medium

27.6%

28.7%

Large

54.1%

52.8%

Hospital location

< 0.0001

Rural

65.3%

76.3%

Urban

93.5%

92.4%

Hospital Teaching Status

Non-teaching

30.0%

29.9%

Teaching

72.0%

70.1%

Expected primary payer

< 0.0001

Medicare

22.1%

28.0%

Medicaid

19.6%

20.8%

Private

51.0%

46.8%

Self-pay

7.3%

4.5%

Median household income(quartile)

< 0.0001

1^st(0-25^th)

25.7%

26.7%

2^nd(26th-50^th)

24.8%

25.7%

3^rd (51st-75^th)

25.3%

25.1%

4^th (76th-100^th)

24.2%

22.4%

Hospital region

< 0.0001

Northeast

21.9%

20.9%

Midwest

25.1%

24.0%

South

36.6%

39.7%

West

16.5%

15.4%

Abbreviations: Median household income for patient’s zip code


	Males (n=83,729)	Females (n= 93,749)	Adjusted Odds Ratio (AOR)	P value
	%	%	(95% CI)
Primary outcome
In-hospital mortality	2.7%	2.9%	0.78 (0.507-1.201)	0.261
Secondary outcomes
Bowel perforation	1.4	1.0	0.69(0.564 – 0.834)	< 0.0001*
Severe sepsis with shock	1.2	1.1	0.81(0.648 – 1.001)	0.051
RBC Transfusion Requirement	4.9	5.3	1.01(0.910 – 1.124)	0.827
			Adjusted mean difference
LOS, mean, days	5.02	4.9	-0.32(-0.444 - -0.206)	< 0.0001*
Total charge, mean USD	45,575	43,013	-4185 (-5618.54- -2752.89)	< 0.0001*
Abbreviations: LOS: Length of Hospital Stay, CI: Confidence Interval, EGD: Endoscopy, USD: United states dollars, * Statistically significant

Table: Table 1: Baseline Patient Demographics and Hospital Characteristics

Table 2: Clinical Outcomes of IBD Hospitalizations Stratified by Sex

Disclosures:

Jennifer Asotibe indicated no relevant financial relationships.

Iriagbonse Asemota indicated no relevant financial relationships.

Katayoun Khoshbin indicated no relevant financial relationships.

Hassam Shah indicated no relevant financial relationships.

Marcelo Ramirez indicated no relevant financial relationships.

Syed Ali Amir Sherazi indicated no relevant financial relationships.

Garima Pudasaini indicated no relevant financial relationships.

Niveda Shekar indicated no relevant financial relationships.

Attar Bashar indicated no relevant financial relationships.

Jennifer Asotibe, MD, Iriagbonse Asemota, MD, Katayoun Khoshbin, MD, Hassam Shah, MD, Marcelo Ramirez, MD, Syed Ali Amir Sherazi, MD, Garima Pudasaini, MD, Niveda Shekar, MD, Attar Bashar, MD. P1606 - Sex Differences in Outcomes of Inflammatory Bowel Disease (IBD) Hospitalizations: A Retrospective Cohort Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.