464 The Burden of Chronic Gastrointestinal Diseases Among the Uninsured: A Free Clinic Study

Abstract

INTRODUCTION: Uninsured and under-insured patients with high comorbidity burden are associated with high costs and high needs. GI diseases make up a significant portion of comorbidity burden and annual health expenditures. There is limited data on GI illnesses among the uninsured. The objective of this study is to do a preliminary evaluation of the burden of chronic GI illness in the uninsured community of Tampa Bay, Florida. METHODS: A retrospective query of an IRB approved database of 5076 patients seen across nine free clinics in the Tampa Bay area in 2017 revealed 760 patients with GI illness. Demographics, substance abuse, prevalence of GI illnesses including GERD, metabolic syndrome, irritable bowel syndrome, inflammatory bowel disease, ulcers, hemorrhoids, hepatitis, chronic liver disease, gallstones, and pancreatitis, were analyzed. Statistical analysis was performed with R 3.5.3. RESULTS: GI patients had a preponderance to be female (62.5%) and Hispanic (57.0%). GERD was the most prevalent condition (13.5%) followed by chronic liver disease (3.6%), GI ulcer (3.2%), hemorrhoids (2.2%), hepatitis C (1.6%), metabolic syndrome (1.5%), gallstones (1.2%), inflammatory bowel syndrome (1.0%), pancreatitis (0.6%), hepatitis B (0.4%), Crohn's disease (0.1%), and hepatitis A (0.1%). Most patients with GI illness have had a history of smoking (34.4% vs. 21.9%, P < .001) or alcohol consumption (30.2% vs. 24.1%, P < .001). Patients with chronic GI illness had more average visits per year than those who did not have chronic GI illness (3.7 vs 2.2 visits per year, P < 0.001). Compared to patients without GI illness, patients with GI illness were older (Mean: 48.7 vs. 39.8 years, SD: 13.1 vs. 17.1, P < .001). CONCLUSION: Patients with chronic GI illness tended have more clinic visits, were more likely to have a comorbid history of smoking and alcohol consumption, and were older than those without GI illness. More education and preventative resources should be directed toward the most common GI illnesses such as GERD, chronic liver disease, and ulcers. Further evaluation of the low-income community is required to identify community level solutions and management strategies for chronic GI illness.