P-096 Women with Inflammatory Bowel Disease Utilize the Emergency Department More than Men Despite Comparable Access to Outpatient Gastroenterology Providers

Abstract

Inflammatory bowel disease (IBD) is a spectrum of disease processes defined by chronic inflammation of the gastrointestinal tract. This chronic illness affects approximately 1.4 million people in the United States and is known to affect men and women equally. There has been an increase in IBD related Emergency Department (ED) visits in recent years. Because of the significant disease burden of IBD, it is important to analyze the trends in ED utilization by IBD patients. Prior studies, although limited, suggest that women generally visit the ED more than men. However, to date, there is no data identifying gender disparities in ED utilization specifically among IBD patients. This study evaluates the frequency of IBD related ED visits and outpatient gastroenterology clinic visits between women and men with IBD. A retrospective chart review of inflammatory bowel disease patients cared for in a 18-month time period at a university medical center was performed. All patients were included. There were no exclusion criteria. Patient age, gender, disease type, frequency of appointments in the gastroenterology clinic, and frequency of IBD related ED visits were obtained. IBD related visit criteria included any gastrointestinal complaints and any possible extraintestinal manifestation of the patient’s IBD (rash, joint pain, ocular complaints). A database, maintaining patient confidentiality, was created. Statistical analysis was performed using a 2-tailed, unpaired t-test with significance set at P < 0.05. The study was approved by the university institutional review board. Three hundred six medical records were reviewed. There were 189 women and 127 men. One hundred seventy-one patients had Crohn's disease and 145 had ulcerative colitis. The mean age was 42.0 years. Seventy-nine (64 women, 15 men) were African-American, 139 were Caucasians (64 women, 75 men), and 85 were undocumented (54 women, 31 men). Women had an average of 0.59 IBD related ED visits. Men had an average of 0.22 IBD related ED visits. Women with IBD were found to have significantly more IBD related ED visits than their male counterparts (P = 0.038). There were no significant racial differences in ED visits among African-American and Caucasian women (P = 0.080). There was no significant difference based on disease type (P = 0.32). Inflammatory bowel disease patients had an average of 3.12 (women 3.30, men 2.90) outpatient gastroenterology visits in an 18-month period. There was no statistically significant difference in the average number of outpatient gastroenterology visits between women and men. It is well known that patients with chronic medical conditions utilize the ED more frequently. However, it is also well known that patients without adequate outpatient care are frequent utilizers of the ED. There is little information regarding the utilization of ED visits by IBD patients and the potential role of gender. This study revealed that women with IBD frequented the ED with IBD related symptoms more than men despite having equivalent outpatient gastroenterology visits. These findings may be attributed to disease perception, pain tolerance, or confounding genitourinary etiologies. However, further study is necessary to evaluate the influence of gender upon emergency department visits by IBD patients.