Geographical and Socioeconomic Disparities in Substance and Opioid Use Disorders Among Inflammatory Bowel Disease Hospitalizations in the United States From the National Inpatient Sample

Objective: We compared substance use disorder (SUD) prevalence among adult inflammatory bowel disease (IBD) hospitalizations with non-IBD controls from the 2016-2018 National Inpatient Sample, assessing correlations with demographics, socioeconomic status, geographic regions, depression, and anxiety. Methods: The primary aim focused on SUD, defined as substance abuse or dependence (International Statistical Classification of Diseases, Tenth Revision [ICD-10]: F10-F19) excluding unspecified use or remission, among hospitalizations documenting IBD (Crohn's disease or ulcerative colitis; ICD-10: K50-51) as one admitting diagnosis (IBD-D). The prevalence of SUD among hospitalizations with and without IBD was compared. The secondary aim further characterized factors influencing SUD among hospitalizations with IBD as the primary diagnosis (IBD-PD). Multivariable logistic regression was performed to estimate the adjusted odds ratios (ORs) for SUD including associated covariates. Results: SUD prevalence was 20.9% for IBD-D and 20.8% for non-IBD controls (P = .38). After adjustments, there was less SUD (OR 0.92, 95% CI, 0.90-0.93) but more opioid use disorder (OUD) (OR 1.20, 95% CI, 1.15-1.24) among IBD-D; other substances were less likely among IBD-D. Among IBD-PD hospitalizations, SUD significantly associated with Crohn's disease (75.1% vs 58.8%, P < .001), Medicaid (30.4% vs 15.8%, P < .001), lowest-income quartile (32.8% vs 23.8%, P < .001), depression (19.1% vs. 12.5%), and anxiety (24.7% vs. 14.9%). These factors were also associated with OUD. Notably, certain geographic regions and urbanization levels correlated with both elevated SUD and OUD among IBD-PD hospitalizations. Conclusions: We comprehensively characterized SUD prevalence among adult IBD hospitalizations, identifying demographic, socioeconomic, geographic, and mental health risk factors for SUD and OUD in IBD. These findings inform efforts to decrease SUD among IBD patients by improving health care delivery through reducing health care disparities and improving psychiatric care.