P0528 - Factors Associated With Poor Compliance Amongst Hospitalized Pediatric Crohn’s Disease Patients

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Nathaniel A. Cohen, MBBCh

University of Chicago Medicine Inflammatory Bowel Disease Center
Chicago, IL, United States

Nathaniel A. Cohen, MBBCh, Dejan Micic, MD, Atsushi Sakuraba, MD, PhD
University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL

Introduction: Compliance with treatment strategies is vital for the control of inflammatory bowel disease (IBD) and the prevention of disease complications. Non-compliance with medication has been a significant issue not only in adult, but also in pediatric IBD patients with rates as high at 66%. This study explored factors associated with poor treatment compliance in a large database hospitalizedpediatric Crohn’s disease (CD) patients.

Methods: This study analyzed data from the Kid’s Inpatient Database (KID) which is the largest publicly available all-payer pediatric inpatient care database in the United States. All available pediatric CD patients non-electively admitted in 2016 were included in the analysis. CD patients were extracted using the standard international classification of diseases (ICD) 10 codes. Data suggesting noncompliance, comorbidities and surgical procedures related to CD were similarly extracted. A multivariable analysis was performed to determine associations between diagnosis of non-compliance and predictor variables.

Results: The 2016 KID database included 2439 pediatric CD patients with non-elective admission. Of these, 113 patients (4.6%) had a diagnosis of non-compliance. There was no difference in median age between those with a diagnosis of non-compliance and those without (median 17 (IQR 13-19) vs 17 (14-19), p=0.46). All demographic details of the cohorts are outlined in Table 1. In univariate analyses, smoking (15.9% vs 5.5%, p< 0.001), cannabis use (5.3% vs 1.5%, p=0.009), and a diagnosis of depression (19.5% vs 9%, p=0.001) or schizoaffective disorder (5.3% vs 0.3%, P< 0.001) were associated with non-compliance. Multivariable analysis revealed that a diagnosis of schizoaffective disorder (odds ratio (OR) 11.6, 95% CI 3.6-37.2), depression (OR 1.9, 95%CI 1.2-3.2) and smoking (OR 2.2, 95%CI 1.25-4) were independently associated with non-compliance.

Discussion: In this study, mental health disorders and smoking were independently associated with non-compliance to medication in admitted CD patients. These factors and other behavioral disorders need to be actively sought and addressed in order to improve treatment compliance and thus disease management in this at-risk patient population.

Variable	Non-compliance reported (n=113)	Non-compliance not reported (n=2326)	P-value
Age - median (IQR)	17 (13-19)	17 (14-19)	0.46
Female - n(%)	56 (49.6)	1106 (47.5)	0.7
CD location
Ileal - n(%)	19 (16.8)	567 (24.4)	0.07
Colonic - n (%)	18 (15.9)	333 (14.3)	0.59
Ileocolonic - n (%)	21 (18.6)	446 (19.2)	0.7
Indeterminate IBD - n (%)	4 (3.5)	105 (4.5)	0.82
Concurrent IBS - n (%)	3 (2.7)	27 (1.2)	0.16
ZIP income status
1st quartile - n(%)	22 (19.5)	451 (19.4)	1
4th quartile - n (%)	40 (35.3)	767 (33)	0.6
Race
White - n (%)	78 (69%)	1587 (68.2)	0.92
Black - n (%)	14 (12.4)	324 (13.9)	0.78
Hispanic - n (%)	10 (8.8)	134 (5.8)	0.22
Asian - n (%)	2 (1.8)	39 (1.7)	0.72
Native American - n(%)	1 (0.9)	11 (0.5)	0.44
Other - n(%)	6 (5.3)	115 (4.9)	0.82
Payer
Medicare - n(%)	0(0)	10 (0.4)	1
Medicaid - n(%)	39 (34.5)	743 (31.9)	0.6
Private insurance - n(%)	71 (62.8)	1484 (63.8)	0.84
Self-pay - n(%)	1 (0.9)	40 (1.7)	1
No charge - n(%)	1 (0.9)	4 (0.2)	0.2
Other - n(%)	0 (0)	41 (1.8)	0.26
Patient location
Central metropolis - n(%)	26 (23)	627 (27)	0.4
Fringe metropolis - n(%)	39 (34.5)	852 (36.6)	0.69
County between 250-999K population - n(%)	27 (23.9)	426 (18.3)	0.14
County between 50-250K population - n(%)	7 (6.2)	192 (8.3)	0.6
Micropolis - n(%)	10 (8.8)	151 (6.5)	0.33
Opioid use - n(%)	2 (1.8)	21 (0.9)	0.29
Steroid use - n(%)	11 (9.7)	158 (6.8)	0.25
Cannabis use - n(%)	6 (5.3)	34 (1.5)	0.009
Smoking - n (%)	18 (15.9)	129 (5.5)	< 0.001
Mental health diagnosis
Any mental health diagnosis - n (%)	38 (33.6)	444 (19.1)	< 0.001
Anxiety - n (%)	17 (15)	258 (11.1)	0.22
ADHD - n (%)	9 (8)	102 (4.4)	0.1
Depression - n(%)	22 (19.5)	209 (9)	0.001
Bipolar mood disorder - n (%)	2 (1.8)	33 (1.4)	0.7
Schizoaffectivedisorder - n(%)	6 (5.3)	7 (0.3)	< 0.001
Autism - n(%)	1 (0.9)	50 (2.1)	0.73
Undergoing surgery - n(%)	20 (17.7)	353 (15.2)	0.5
Disease complication
Perforation - n(%)	4 (3.5)	68 (2.9)	0.58
Intestinal obstruction - n (%)	4 (3.5)	111 (4.8)	0.82
Perianal abscess - n(%)	7 (6.2)	120 (5.2)	0.66
Peritoneal abscess - n(%)	1 (0.9)	57 (2.5)	0.5
Psoas abscess - N(%)	0(0)	13 (0.6)	1
Retroperitoneal abscess - N(%)	0(0)	2 (0.1)	1

Table: Table 1: Demographic and hospitalization details of the patient cohorts

Disclosures:

Nathaniel Cohen indicated no relevant financial relationships.

Dejan Micic indicated no relevant financial relationships.

Atsushi Sakuraba indicated no relevant financial relationships.

Nathaniel A. Cohen, MBBCh, Dejan Micic, MD, Atsushi Sakuraba, MD, PhD. P0528 - Factors Associated With Poor Compliance Amongst Hospitalized Pediatric Crohn’s Disease Patients, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.