Lower socioeconomic status tied to poor outcomes in IBD

A lower socioeconomic status (LSS) can lead to worse outcomes in individuals with inflammatory bowel disease (IBD), suggests a recent study.

A total of 9,298 residents in Manitoba, Canada, were identified from 1 April 1995 to 31 March 2018 using a validated case definition to the Manitoba Health administrative database. Outpatient physician visits, hospitalizations, surgeries, intensive care unit admissions, and prescription medications were also identified. Data were linked to two databases, one identifying individuals who received Employment and Income Assistance and another identifying those with Child and Family Services contact.

Area-level socioeconomic status was defined using a factor score that incorporated 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.

Individuals with LSS had increased rates of annual outpatient physician visits (relative risk [RR], 1.10, 95 percent confidence interval [CI], 1.06–1.13), hospitalizations (RR, 1.38, 95 percent CI, 1.31–1.44), intensive care unit admissions (RR, 1.94, 95 percent CI, 1.65–2.27), use of corticosteroids >2,000 mg/year (RR, 1.12, 95 percent CI, 1.03–1.21), and death (hazard ratio, 1.53, 95 percent CI, 1.35–1.73) compared to those without any markers of LSS.

Narcotics (RR, 2.17, 95 percent CI, 2.01–2.34) and psychotropic medication use (RR, 1.98, 95 percent CI, 1.84–2.13) were also increased. Of note, LSS had greater impact on individuals with Crohn’s disease than on those with ulcerative colitis.

“Social determinants of health at time of diagnosis should be highly considered and addressed,” the authors said.