P2361 - Evaluation of Disease Surveillance and Outcomes for Patients With Primary Sclerosing Cholangitis and Inflammatory Bowel Disease Stratified by Index of Neighborhoods Experiencing Socioeconomic Disadvantage

Monday, October 23, 2023

10:30 AM – 4:15 PM PT

Location: Exhibit Hall

Presenting Author(s)

Olivia Michaels, BA (she/her/hers)

UMass Chan Medical School
Worcester, MA

Harris Feldman, MD, Olivia Michaels, BA, Abbas Rupawala, MD, Navine Nasser-Ghodsi, MD
UMass Chan Medical School, Worcester, MA

Introduction: Primary sclerosing cholangitis (PSC) is a chronic, progressive, biliary disease highly associated with inflammatory bowel disease (IBD). Patients with PSC require routine surveillance for hepatobiliary malignancy and hepatic synthetic function. Patients with both PSC and IBD are at an increased risk of colorectal cancer and the added burden of medications or surgery directed at IBD management. This complex disease population may have higher healthcare utilization and differences in social determinants could impact disease outcomes. In this study, we explored the relationship between geographic socioeconomic disadvantage and PSC and IBD disease monitoring and management.

Methods: This single-center retrospective cohort study included patients with the diagnosis of PSC (ICD-10 K83.01) by a TriNetX query and documented as having confirmed PSC stratified by their addresses’ Area Deprivation Index (ADI). The ADI was created by the Health Resources & Services Administration and ranks neighborhoods from 1-100 by national socioeconomic disadvantage¹. ADI groups were identified as least disadvantaged (1-25), 2^nd most disadvantaged (26-50), and most disadvantaged (51-100). Comparative analysis of healthcare maintenance, PSC, and IBD (ICD-10 K51.90) outcomes was based on a chi-square test of independence.

Results: 109 patients were reviewed with 84 patients meeting study criteria finding a mean age of 51 (range 16-90), 97% had a Massachusetts address, and a diagnosis of PSC-only in 21/84 (25%) or PSC-IBD in 63/84 (75%). ADI group distribution showed least disadvantaged 31/84 (37%), second most disadvantaged 36/84 (43%), and most disadvantaged 17/84 (20%). Healthcare maintenance outcomes of cholangiocarcinoma surveillance had statistically significant differences between groups (62%, 81%, 47%; p=0.03) while other outcomes comparisons depicted in Figure 1 had varying proportions that were not significant. PSC and IBD disease outcomes listed in Table 1 had similar rates between ADI groups but were not statistically significant.

Discussion: This study analyzed the distribution of health outcomes for patients with PSC by neighborhood disadvantage and found that socioeconomic differences between neighborhoods may impact disease monitoring and surveillance rates for patients with PSC-only or PSC-IBD.

1. Kind AJH, Buckingham W. Making Neighborhood Disadvantage Metrics Accessible: The Neighborhood Atlas. New England Journal of Medicine, 2018. 378: 2456-2458

Figure: Figure 1. Proportion of health maintenance outcome met by patients stratified by ADI groups. P-values based on chi-squared test of independence

PSC Disease Outcomes n=84	Least Disadvantaged (ADI 1-25) n=31	Second Most Disadvantaged (ADI 25-50) n=36	Most Disadvantaged (ADI 51-100) n=17	P-value
Fibrosis at Diagnosis F0 F1 F2 F3 F4	n=26 7 5 1 2 11	n=27 9 2 3 6 7	n=13 1 4 2 2 4	0.31
Lifetime # of ERCPs 0 1-5 6-10 >10	n=28 11 13 3 1	n=33 14 12 5 2	n=17 8 5 1 3	0.55
Cirrhosis n (%)	n=30 15 (50)	n=36 13 (36)	n=17 8 (47)	0.19
Transplanted n (%)	n=30 7 (23)	n=36 4 (11)	n=17 2 (11)	0.37
Malignancy n (%)	n=30 4 (13)	n=35 4 (12)	n=17 4 (24)	0.51
IBD Disease Outcomes n=63
Disease phenotype Crohn's Ulcerative colitis IBD-unspecified	n=21 7 14 0	n=29 11 16 2	n=13 6 6 1	0.89
Escalated to biologics n (%)	n=21 11 (52)	n=29 9 (31)	n=13 7 (54)	0.21
Surgical intervention n (%)	n=21 7 (33)	n=29 3 (10)	n=13 1 (7)	0.06

Disclosures:

Harris Feldman indicated no relevant financial relationships.

Olivia Michaels indicated no relevant financial relationships.

Abbas Rupawala: Abbvie – Speakers Bureau. bristol Myers squibb – Advisory Committee/Board Member, Consultant.

Navine Nasser-Ghodsi indicated no relevant financial relationships.

Harris Feldman, MD, Olivia Michaels, BA, Abbas Rupawala, MD, Navine Nasser-Ghodsi, MD. P2361 - Evaluation of Disease Surveillance and Outcomes for Patients With Primary Sclerosing Cholangitis and Inflammatory Bowel Disease Stratified by Index of Neighborhoods Experiencing Socioeconomic Disadvantage, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.