P2647 - A Comprehensive Evaluation of Social Determinants of Health in IBD: How Barriers Impact IBD Outcomes and Mental Health

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Gabriela Kuftinec, MD, MPH

University of Miami, Jackson Memorial Hospital
Miami, FL, United States

Gabriela Kuftinec, MD, MPH¹, Oriana Damas, MD², Nidah S. Khakoo, MD¹, Diana Morillo, BSN³, Maria Alejandra Quintero, MPH³, James Leavitt, MD, FACG⁴, Joanna Lopez, MD⁴, David Kerman, MD², Maria T. Abreu, MD⁵, Amar Deshpande, MD², Seth Schwartz, PhD⁶, Ana Palacio, MD²
¹University of Miami, Jackson Memorial Hospital, Miami, FL; ²University of Miami Miller School of Medicine, Miami, FL; ³University of Miami Health System, Miami, FL; ⁴Gastro Health, Miami, FL; ⁵Crohn's and Colitis Center, University of Miami Miller School of Medicine, Miami, FL; ⁶University of Texas at Austin, Austin, TX

Introduction: The impact of social determinants of health (SDoH) in inflammatory bowel disease (IBD) remains understudied. We performed a comprehensive evaluation of established SDoH in a South Florida population of IBD patients. We then evaluated the impact of these social barriers on IBD outcomes.

Methods: We performed a cross-sectional study on adult IBD patients across three different practice settings (tertiary referral center, safety net hospital and community practice). We collected information on SDoH including financial and food insecurity, foreign-born status, social isolation and health literacy. We created cumulative social barriers scores (SBS) for each individual by summing the total number of social barriers present for each participant (Table 1). We used multivariable logistic regression and general linear models to assess the impact of cumulative barriers on IBD outcomes including depression symptoms, perceived health status, disease complications (surgeries, hospitalizations) and disease activity (measured using the Harvey Bradshaw index and simple clinical colitis activity score).

Results: A total of 316 patients were included: 64.71% Hispanic. Prevalent social barriers were financial strain (38.4%), infrequent large social gatherings (32.9%), delay in medical care (29.1%) and low educational attainment (26.8%). (Figure 1). Non-Hispanic Blacks (NHB) had the greatest number of social barriers, followed by Hispanics and non-Hispanic whites (NHW) (M 4.50 (SD 1.72), M 3.87 (SD 1.88), M 2.66 (SD 1.45), respectively), p< 0.0001. Social barriers associated with poor IBD outcomes were lower education levels, health illiteracy, and financial insecurity. A high SBS was associated with greater depression symptoms (OR 1.94, 95% CI 1.21-2.9, p=.001) and lower reported use of medications, including immunomodulators (OR=0.86, 95% CI 0.76-0.98, p=0.02). Greater ulcerative colitis (UC) disease activity was seen in patients with greater SBS, with every one-point increase in the SBS resulting in increased UC disease activity by 0.45 (p=0.03). No associations were identified between SBS and Crohn’s disease activity, IBD surgeries, hospitalizations, biologic use, and disease location.

Discussion: Our study identifies a high burden of social barriers in NHB and Hispanics with IBD. In turn, these impact disease activity and mental health. Future studies should focus on implementing interventions that reduce barriers impeding health care equity.

Figure: Prevalence of Social Barrier stratified by ethnicity and race
*: statically significant when comparing the variable by ethnicity and race

Domain	Reference answer	Presence of SDoH risk
Nativity	Born in the US	Foreign born
Education level	Some college or more	High school or less
Housing	Has a home	Has no home or is at risk of losing home
Confident filling forms	Quite and extremely comfortable	Not at all, little, or somewhat
Financial strain	Not hard paying for basics	Somewhat and very hard
Talk on the phone with relatives or friends	Once or more a week	Less than once a week
Get together	Once or more a week	Less than once a week
Attend Church	4 or more times a year	Less than 4 times a year
Attend meetings	4 or more times a year	Less than 4 times/year
Delaying medical care in past 12 months	No	Yes

Table: Table 1. Social determinants of health domains used to create a composite social barrier score.

Disclosures:
Gabriela Kuftinec indicated no relevant financial relationships.
Oriana Damas indicated no relevant financial relationships.
Nidah Khakoo indicated no relevant financial relationships.
Diana Morillo indicated no relevant financial relationships.
Maria Alejandra Quintero indicated no relevant financial relationships.
James Leavitt indicated no relevant financial relationships.
Joanna Lopez indicated no relevant financial relationships.
David Kerman: Cleveland Clinic – Consultant. Genentech – Advisory Committee/Board Member. Rebiotix – Advisory Committee/Board Member.
Maria Abreu indicated no relevant financial relationships.
Amar Deshpande: American Board of Internal Medicine – Advisory Committee/Board Member. GI Health Foundation – Advisory Committee/Board Member. Takeda – Grant/Research Support.
Seth Schwartz indicated no relevant financial relationships.
Ana Palacio indicated no relevant financial relationships.

Gabriela Kuftinec, MD, MPH¹, Oriana Damas, MD², Nidah S. Khakoo, MD¹, Diana Morillo, BSN³, Maria Alejandra Quintero, MPH³, James Leavitt, MD, FACG⁴, Joanna Lopez, MD⁴, David Kerman, MD², Maria T. Abreu, MD⁵, Amar Deshpande, MD², Seth Schwartz, PhD⁶, Ana Palacio, MD². P2647 - A Comprehensive Evaluation of Social Determinants of Health in IBD: How Barriers Impact IBD Outcomes and Mental Health, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.