S529 Do Social Determinants of Health Impact Which Patients Are Referred for the Low FODMAP Diet?

Abstract

Introduction: The aim of this study was to explore if differences in social determinants of health in irritable bowel syndrome (IBS) patients impact access to the low FODMAP diet (LFD). Methods: A prospective cross-sectional survey of 486 adults was performed from May – June 2022. All respondents completed a 31-question survey via Survey Monkey. The survey link was distributed via social media platforms, low FODMAP dietician blog posts, and the IFFGD newsletter. Questions consisted of social determinants, such as the number of family members in their home, education attainment, employment status, healthcare insurance, access to healthcare, housing, utilities, transportation, childcare, and food access and insecurities. Statistical analyses included the Mann-Whitney U test and chi-square test. A p-value of ≤ 0.05 was considered statistically significant. Results: 462/486 (95.1%) respondents reported a diagnosis of IBS. Patients without a diagnosis of IBS were removed from the analysis. IBS cohort demographics consisted of 93% female, 92.5% Caucasian, and 92.7% residing in the United States. The primary IBS complaint was equally distributed: IBS-Diarrhea (35.1%), IBS-Constipation (29.1%), and IBS-Mixed (35.1%). 83.6% (n = 400) of IBS respondents were recommended the low FODMAP diet for treatment of their GI symptoms by a medical provider. IBS respondents were divided into two groups: IBS-LFD+ (n = 400, those referred for low FODMAP diet education) and IBS-LFD- (n = 62, those not referred for low FODMAP diet education). Compared with their IBS-LFD+, IBS-LFD- respondents had a lower education level (14.8% with high school diploma or less vs. 5.8%, p =0.01), lower household income (46.7% with income ≤ $74,999 vs. 30.7%, p =0.03), and decreased access food when needed (8.1 vs. 2.8 %, p = 0.03). IBS-LFD- respondents were also less likely start a low FODMAP diet on their own compared to IBS-LFD+ counterparts (12.4% vs. 87.6%, p < 0.001). Conclusion: IBS patients with a lower socioeconomic position were less likely to be recommended the low FODMAP diet as treatment compared to patients with higher socioeconomic positioning. This raises concern socioeconomic status negatively impacts referral for low FODMAP diet for IBS management and suggests implicit referral bias. Given the increasing evidence for dietary therapy for managing GI symptoms, further investigation is needed to identify how provider perceptions of patients influence dietary treatment recommendations. Table 1. - Comparison of social determinants between IBS patients recommended vs. NOT recommended the low FODMAP diet by their health provider Social Determinant Variable IBS patients recommended low FODMAP Diet [IBS-LFD+](n = 400) IBS patients NOT recommended low FODMAP Diet[IBS-LFD-](n = 62) P-Value Cramer V Coefficient Odds Ratio (OR) 95% Confidence Interval (CI) Highest Level of Education Attainment High school diploma/ GED or less 5.8% 14.8% 0.01 0.12 2.31 1.26, 4.25 ≥ High School Diploma/GED 94.2% 85.2% Household Income $0.00 - $74,999 30.7% 46.7% 0.03 0.11 1.81 1.05, 3.11 ≥ $75,000 69.3% 53.3% Access to Food When Needed Unable to access food when needed 2.8% 8.1% 0.03 0.10 2.45 1.14, 5.26 Likely to start low FODMAP diet on their own Yes 87.6% 12.4% < 0.001 0.19 0.28 0.16, 0.50 No 56.6% 44.4% Visit a registered dietitian about the low FODMAP diet Yes 88.2% 11.8% 0.06 0.09 0.64 0.40, 1.03 No 81.6% 18.4%