Ankit Chhoda, MD1, Anabel Liyen Cartelle, MD1, Shaharyar Zuberi, MD1, Kelsey Anderson, MD1, Shivani Gulati, 1, Miriam Olivares, MS2, Awais Ahmed, MD1, Ishani Shah, MD3, Darshan Kothari, MD4, Steven Freedman, MD, PhD1, Loren Rabinowitz, MD1, Sunil G. Sheth, MD1 1Beth Israel Deaconess Medical Center, Boston, MA; 2Yale University, New Haven, CT; 3University of Utah School of Medicine, Salt Lake City, UT; 4Duke University School of Medicine, Durham VA Medical Center, Durham, NC
Introduction: Prior studies have examined the impact of certain social determinants of health on acute pancreatitis (AP) outcomes, but have not assessed the influence of the local environment. Geospatial analysis integrates location-based data with clinical information to help identify vulnerable communities. In this study, we examined the association of social vulnerability index (SVI; US Centers for Disease Control and Prevention measure of vulnerability to disasters or pandemics) with AP outcomes.
Methods: We geocoded AP inpatients from 1/1/2008 to 12/31/2018 at a large tertiary center (Fig 1A). We calculated overall SVI from its 4 subcomponents (1) socioeconomic status, 2) household composition & disability, 3) minority status & language, & 4) housing type & transportation) using 15 social attributes (Fig 1B). SVIs were classified into quartiles: [I=0-0.25(least vulnerable) & IV= 0.75-1.00 (most vulnerable)]. The demographics, clinical features, hospital course, and outcomes of AP patients in the SVI quartiles were delineated and compared. The categorical variables were expressed as ratios and underwent Chi-square test. Continuous variables were expressed as median and interquartile range and underwent Kruskal Wallis test.
Results: AP patients (n=839) from SVI quartiles I: 278, II: 231, III: 153, & IV: 177 had similar age & sex distribution, active smoking, alcohol use, and AP etiology. Higher SVI had increased federal/state insurance (P<0.001) and more racial minorities (P<0.001) (Fig 1C). The comparison of SVI quartiles showed no difference in BISAP score, total Morphine Milligram Equivalent requirements and time to feeding (Fig 1C; Table 1). AP patients from SVI quartiles had similar local complications, respiratory failure, acute kidney injury, and ICU stay. However, the most socially vulnerable patients had significantly higher rates of alcohol withdrawal (P=0.03). Although mortality, length of stay, and rehabilitative requirements were similar, SVI IV had significantly higher number of readmissions in 1 year compared to SVI I (P=0.04).
Discussion: SVI is a promising composite variable to study AP outcomes beyond unidimensional patient characteristics. We noted significantly higher readmissions and alcohol withdrawal in AP patients with higher social vulnerability. Strong consideration should be given to factors contributing to higher SVI to optimize discharge planning and follow-up.
Figure: Figure 1: (A) Geocoded Acute Pancreatitis patients cared for at a large tertiary center (B) Social Vulnerability Index based on subcomponents and social attributes (C) Acute Pancreatitis patient demographics, clinical course, and outcomes
Disclosures:
Ankit Chhoda indicated no relevant financial relationships.
Anabel Liyen Cartelle indicated no relevant financial relationships.
Shaharyar Zuberi indicated no relevant financial relationships.
Kelsey Anderson indicated no relevant financial relationships.
Shivani Gulati indicated no relevant financial relationships.
Miriam Olivares indicated no relevant financial relationships.
Awais Ahmed indicated no relevant financial relationships.
Ishani Shah indicated no relevant financial relationships.
Darshan Kothari indicated no relevant financial relationships.
Steven Freedman indicated no relevant financial relationships.
Loren Rabinowitz indicated no relevant financial relationships.
Sunil G. Sheth indicated no relevant financial relationships.
Ankit Chhoda, MD1, Anabel Liyen Cartelle, MD1, Shaharyar Zuberi, MD1, Kelsey Anderson, MD1, Shivani Gulati, 1, Miriam Olivares, MS2, Awais Ahmed, MD1, Ishani Shah, MD3, Darshan Kothari, MD4, Steven Freedman, MD, PhD1, Loren Rabinowitz, MD1, Sunil G. Sheth, MD1. P2874 - Social Vulnerability Impacts Hospital Readmission and Alcohol Withdrawal in Acute Pancreatitis: Results of Geospatial Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.