Social Determinants of Outcomes in Inflammatory Bowel Disease

INTRODUCTION: In a population-based inflammatory bowel disease (IBD) cohort, we aimed to determine whether having lower socioeconomic status (LSS) impacted on outcomes. METHODS: We identified all 9,298 Manitoba residents with IBD from April 1, 1995, to March 31, 2018 by applying a validated case definition to the Manitoba Health administrative database. We could identify all outpatient physician visits, hospitalizations, surgeries, intensive care unit admissions, and prescription medications. Their data were linked with 2 Manitoba databases, one identifying all persons who received Employment and Income Assistance and another identifying all persons with Child and Family Services contact. Area-level socioeconomic status was defined by a factor score incorporating average household income, single parent households, unemployment rate, and high school education rate. LSS was identified by any of ever being registered for Employment and Income Assistance or with Child and Family Services or being in the lowest area-level socioeconomic status quintile. RESULTS: Comparing persons with LSS vs those without any markers of LSS, there were increased rates of annual outpatient physician visits (relative risk [RR] = 1.10, 95% confidence interval [CI] = 1.06–1.13), hospitalizations (RR = 1.38, 95% CI = 1.31–1.44), intensive care unit admission (RR = 1.94, 95% CI = 1.65–2.27), use of corticosteroids >2,000 mg/yr (RR = 1.12, 95% CI = 1.03–1.21), and death (hazard ratio 1.53, 95% CI = 1.36–1.73). Narcotics (RR = 2.17, 95% CI = 2.01–2.34) and psychotropic medication use (RR = 1.98, 95% CI = 1.84–2.13) were increased. The impact of LSS was greater for those with Crohn's disease than for those with ulcerative colitis. DISCUSSION: LSS was associated with worse outcomes in persons with IBD. Social determinants of health at time of diagnosis should be highly considered and addressed.