P-045 Race and Patient’s Income Have A Significant Impact on Health Outcomes in Hospitalized Patients With Crohn’s Disease (CD)-Related Complications

Abstract

CD is a chronically relapsing and debilitating condition, which is frequently complicated by penetrating disease (intra-abdominal fistula), stricturing disease (bowel obstruction), and perianal disease. The hospitalizations of patients with these complications have increased lately. However, the impacts of race and patient’s income on hospital outcomes of patients with these complications were unknown. The aim of our study was to examine the impacts of race and income on health outcomes in hospitalized patients with CD-related complications. This was a cross-sectional study using data from the Nationwide Inpatient Sample (NIS, 2009-2011). Hospitalizations with CD-related complications, including penetrating disease, stricturing disease, and perianal disease, between 2009 and 2011 were identified using appropriate ICD-9-CM codes. Exclusion criteria included: (1) Age < 19 years; (2) Carrying discharge diagnosis of both UC and CD. In-hospital mortality, health care costs, length of hospital stay (LOS), resource utilization (receiving blood products and parental nutrition), likelihood of receiving surgeries, and incidence of post-surgical complications of patients with CD-related complications were compared among different ethnicity and income groups. The grades of income were determined based on the ZIP codes of patient’s residence. The low income was between $1 and $38,999 annually, the medium income was between $39,000 and $63,999 annually, and the high income was higher than $64,000 annually. Statistical analysis: Multivariate linear and logistic regression models were used to compare the hospital outcomes of patients among different ethnicity and income groups. After excluding patients with missing values of race, a total of 70,383 hospitalized patients with CD-related complications were identified, among which 79.64% was white, 12.16% was black, 4.34% was Hispanic, and 3.86% was of another race. Race significantly impacted the frequency of receiving blood products and surgery among hospitalized patients with CD-related complications (P = 0.0204 and P = 0.0057, respectively). Compared with white patients, black patients more likely received blood products [odds ratio (OR) 1.34, 95% confidence interval (CI) 1.10–1.64)] and less likely received surgery (OR 0.80, 95%CI, 0.70–0.92). After excluding patients with missing data on income, a total of 80,250 hospitalized patients with CD-related complications were identified, among which 23.40% had low income, 51.46% had medium income, and 25.14% had high income. Income of patients significantly impacted the incidence of post-surgical complications and LOS among hospitalized patients with CD-related complications (P = 0.0347 and P = 0.025, respectively). Compared with patients with low income, patients with medium and high income were less likely to develop post-surgical complications (OR 0.87, 95% CI, 0.78–0.97; OR 0.86, 95% CI, 0.75–0.90, respectively) and stayed 0.39 (95% CI, −0.05, 0.83) and 0.68 (95% CI, 0.18, 1.18) days shorter. In hospitalized patients with CD-related complications, race is associated with frequency of receiving blood products and surgery. Black patients more likely received blood products and less likely received surgery than white patients. Income of patients is also associated with the incidence of post-surgical complications and LOS. Patients with low income more likely developed post-surgical complications and had prolonged LOS compared with patients with medium and high income.