P1059 - Does Race Affect Outcomes in Chronic Pancreatitis?

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Rachel L. Bocchino, MD

Beth Israel Deaconess Medical Center, Harvard Medical School
Boston, MA, United States

Rachel Bocchino, MD¹, Ishani Shah, MD¹, William Yakah, BS¹, Awais Ahmed, MD¹, Steven D. Freedman, MD, PhD¹, Darshan J. Kothari, MD², Sunil G. Sheth, MD¹
¹Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; ²Duke University Medical Center, Durham, NC

Introduction: Chronic pancreatitis (CP) is characterized by progressive inflammation and fibrosis of the pancreas resulting in abdominal pain, endocrine and exocrine insufficiency and secondary complications. There is limited data comparing the natural history of CP in patients of different races. The aim of our study was to assess the disease characteristics and outcomes in Caucasian patients with CP compared to non-Caucasian patients with CP.

Methods: We retrospectively analyzed all patients with an established diagnosis of CP who were followed in the Pancreas Center at our institution between 2018 and 2020. We then compared demographic characteristics including self-reported race, comorbidities, outcomes and resource utilization between Caucasian and non-Caucasian patients.

Results: Out of the 445 patients with CP, 330 (74.2%) were Caucasian and 115 non-Caucasian (47 African-American, 23 Hispanic, 45 other). Apart from a higher proportion of Caucasian patients being women (50.9% vs 36.5%; p=0.045), there were no significant differences between the demographics of the groups. Non-Caucasian patients were more likely to have a history of alcohol dependence (46.1% vs 29.7%; p=0.006) and CP due to alcohol (46.1% vs 29.4%; p=0.028). A higher proportion of Caucasian patients had associated psychiatric illness (55.8% vs 40.9%; p=0.021) and cardiac disease (35.5% vs 24.8%; p=0.048). As shown in the table below, there were no significant differences in associated symptoms, complications, medication use or resource utilization.

Discussion: Although some demographic and comorbidities of Caucasian patients with CP differ from non-Caucasian patients, there is no difference in outcomes including chronic abdominal pain, use of controlled substances, hospitalizations for flares or need for procedural intervention. Further work is needed to identify any specific areas of healthcare disparities that may exist in the management patients of different races and ethnicities.

	Caucasian (n=330)	Non-Caucasian (n=115)	p-value
Demographics
Age	58.9 (15.0)	56.6 (14.9)	0.150
Gender			0.011
Male	162 (49.1%)	73 (63.5%)
Female	168 (50.9%)	42 (36.5%)
Disabled/Unemployed	52 (17.6%)	21 (19.4%)	0.784

Etiology			0.028
Alcohol	97 (29.4%)	53 (46.1%)
Biliary	25 (7.6%)	7 (6.1%)
Idiopathic	155 (46.9%)	42 (36.5%)
Other	51 (15.5%)	13 (11.3%)

Comorbidities
Tobacco use	215 (65.2%)	68 (59.1%)	0.357
Alcohol dependence	98 (29.7%)	53 (46.1%)	0.006
Psychiatric illness	184 (55.8%)	47 (40.9%)	0.021
Non-pancreatitis chronic pain	49 (15.3%)	17 (15.9%)	1.000
Cardiac disease	115 (35.5%)	28 (24.8%)	0.048
Pulmonary disease	102 (31.5%)	28 (24.8%)	0.222
Liver disease	35 (10.8%)	16 (14.2%)	0.425
CKD	43 (13.2%)	16 (14.2%)	0.929

Associated Complications
Chronic abdominal pain	239 (74.0%)	81 (71.7%)	0.723
Exocrine pancreatic insufficiency	194 (60.2%)	62 (54.9%)	0.374
Gastroparesis	91 (28.1%)	26 (23.0%)	0.354
SIBO	95 (29.4%)	33 (29.2%)	1.000
Splanchnic vein thrombosis	43 (13.3%)	9 (7.96%)	0.183
Pseudocyst	117 (36.1%)	42 (36.8%)	0.979
Biliary obstruction	57 (17.9%)	11 (9.73%)	0.059
Vitamin D deficiency	124 (42.6%)	42 (38.9%)	0.578
Pancreatic malignancy	15 (4.66%)	2 (1.79%)	0.259

Medication Use
Pancreatic enzymes	212 (65.2%)	77 (68.1%)	0.655
Non-opioid controlled medications	99 (30.5%)	23 (20.4%)	0.052
Opioids	157 (48.2%)	59 (51.8%)	0.581
Neuromodulators	162 (49.8%)	50 (44.6%)	0.401

Resource Utilization
Recurrent ED visits for opioid prescriptions	21 (6.50%)	9 (7.96%)	0.754
Celiac block	50 (15.4%)	12 (10.7%)	0.287
Surgery for CP	50 (15.4%)	9 (8.04%)	0.070
Mean number of flares requiring hospitalization in the last 2 years	2.23 (3.31)	2.46 (3.57)	0.546
Mean number of CTs since diagnosis	3.16 (3.01)	3.50 (3.30)	0.348
Mean number of ERCPs since diagnosis	1.19 (1.79)	1.33 (2.21)	0.553

Table: Comparison Between Caucasian and Non-Caucasian Patients with Chronic Pancreatitis

Disclosures:
Rachel Bocchino indicated no relevant financial relationships.
Ishani Shah indicated no relevant financial relationships.
William Yakah indicated no relevant financial relationships.
Awais Ahmed indicated no relevant financial relationships.
Steven Freedman indicated no relevant financial relationships.
Darshan Kothari indicated no relevant financial relationships.
Sunil Sheth indicated no relevant financial relationships.

Rachel Bocchino, MD¹, Ishani Shah, MD¹, William Yakah, BS¹, Awais Ahmed, MD¹, Steven D. Freedman, MD, PhD¹, Darshan J. Kothari, MD², Sunil G. Sheth, MD¹. P1059 - Does Race Affect Outcomes in Chronic Pancreatitis?, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.