Chung Sang Tse, MD1, Samir A. Shah, MD, FACG2, Sumona Saha, MD3, Sasha Taleban, MD4, Sara Horst, MD, MPH5, Megan Lutz, MD6, Hannah Fiske, MD7, Chien-Hsiang Weng, MD, MPH7, Melissa G.. Hunt, PhD1, Lily Brown, PhD1, Brittaney Bonhomme, BS1, Robert Kuehnel, PhD8, Alandra Weaver, MPH9, Raymond Cross, MD10, Millie D. Long, MD, MPH11, James Lewis, MD, MSCE1 1University of Pennsylvania, Philadelphia, PA; 2Gastroenterology Associates, Inc., Providence, RI; 3University of Wisconsin, Milwaukee, WI; 4University of Arizona College of Medicine, Tucson, AZ; 5Vanderbilt University Medical Center, Nashville, TN; 6University of Wisconsin, Milaukee, WA; 7Brown University, Providence, RI; 8Lafayette, NY; 9Crohn's and Colitis Foundation, New York, NY; 10University of Maryland, Baltimore, MD; 11UNC Chapel Hill, Chapel Hill, NC
Introduction: IBD impacts an individual’s education and employment participation, economic and social activities, and physical and psychosocial function – a concept encapsulated as ‘IBD-related disability’. We aim to identify disease- and patient-related factors, including health-related social needs, associated with IBD-related disability.
Methods: We surveyed adults with IBD at 3 GI practices (2 academic centers; 1 private community practice) from Feb-Apr 2023. To identify patient/disease factors associated with moderate-to-severe IBD-related disability (vs. no/lowdisability, measured by the IBD Disability Index), we used Wilcoxon rank sum or χ2 tests and logistic regression models with variables determineda priori: gender, age, IBD subtype, IBD disease activity (2-item patient-reported outcome, PRO-2), IBD knowledge (Crohn’s and Colitis Knowledge Score), and health-related social needs across 4 domains of housing instability, food security, transportation needs, and utility needs (Centers for Medicare & Medicaid Services Health-Related Social Needs Screening Tool).
Results: Of the 239 adults with IBD surveyed (63% CD, 37% UC; 79% active, 21% remission; median age 36 years; 58% female; 85% White, 9% Black; 87% post-secondary education; 80% working/studying; 61% married), nearly half (44%) had moderate-to-severe IBD-related disability (Tab 1). Over one-fifth (23%) of patients have at least one health-related social need (mean 0.4, 95% CI 0.3-0.5); poor housing quality (12%) and food insecurity (9%) were the most common.
On multivariable analysis, active disease (aOR 6.3, 95% CI 2.1-10.3) and health-related social needs (any vs. none: aOR 7.3, 95% CI 3.4-16.0) were independently associated with moderate-to-severe IBD-related disability, but gender, age, IBD subtype, and IBD-specific knowledge were not (Fig 1). The presence of each health-related social need was associated with a 3-fold increased risk for moderate-to-severe IBD-related disability (aOR 3.1, 95% CI 1.8-5.3).
Discussion: IBD disease activity and health-related social needs are independently associated with IBD-related disability. Housing instability and food insecurity are independently associated with a 3-fold risk for IBD-related disability. Pharmacologic IBD-directed therapies to reduce disease activity and non-pharmacologic interventions that target social determinants of health are both necessary for a holistic approach to IBD care to reduce the overall burden of IBD disability.
Table: Table 1: Patient Demographics and Disease Characteristics Abbreviations: IBD; inflammatory bowel diseases; IQR, interquartile range *IBD remission was defined using the 2-item patient-reported outcome measure (PRO-2) for stool frequency (SF), abdominal pain (AP), and rectal bleeding (RB): SF=0/RB=0 for ulcerative colitis (UC) and SF≤3/AP≤1 for Crohn’s disease (CD).
Disclosures:
Chung Sang Tse indicated no relevant financial relationships.
Samir Shah indicated no relevant financial relationships.
Sumona Saha indicated no relevant financial relationships.
Sasha Taleban indicated no relevant financial relationships.
