P0197 - Decreased Healthcare Utilization in Uninsured Patients With Perianal Crohn’s Disease Undergoing Proctectomy

Yonatan Israel, BS¹, Vladislav Izda, BS¹, Regina Longley, BA¹, Monica Feeley, BA¹, Esther Kim, BS¹, Cecilia Katzenstein, BA¹, Nikhil Maheshwari, BS¹, Patricia Sylla, MD², Sergey Khaitov, MD², Alexander Greenstein, MD, MPH², Serre-yu Wong, MD, PhD^2
1Icahn School of Medicine at Mount Sinai, New York, NY; ²Mount Sinai Hospital, New York, NY

Introduction: Perianal Crohn's disease (CD) is a debilitating manifestation of CD associated with poor outcomes, decreased quality of life, and is an independent predictor of work disability. Proctectomy is a last resort reserved for patients with severe, refractory disease, and can be associated with high morbidity. Here we investigate the effect of insurance status on these patients’ healthcare utilization, and its impact on disease progression.

Methods: This is a retrospective study following perianal CD patients who underwent a proctectomy from 2008 - 2021 at Mount Sinai Hospital. Patient characteristics were compared using Chi-Square or Fisher's Exact Tests. Outcome variables were compared using univariate analysis between patients with and without insurance.

Results: Our study included 130 patients (50.8% female) with a mean age of 52.0 ± 14.9 years, and the majority were insured (n = 106, 81.5%). Results were significant for a shorter diagnosis-to-surgery time in the uninsured group (6.9 vs. 11.1 years, p = 0.050), fewer hospitalizations (p = 0.002), MRIs (p = 0.008), clinic visits (p = 0.007), antibiotics (p = 0.016) , and biologics (p =0.001) in the uninsured group (Table 1). Additionally, data trended towards a later mean age at time of diagnosis in the uninsured group (37.8 vs. 33.1 years, p = 0.241). There was no statistical difference between the groups regarding race, comorbidities, extraintestinal manifestations, presence of skin tags, strictures, and fissures, presence of proctitis or abscess at proctectomy, age at proctectomy, surgical approach, number of lifetime GI surgeries, endoscopies, or corticosteroid treatments.

Discussion: Results suggest that the vulnerable, perianal CD uninsured sub-population has decreased utilization of healthcare resources compared to the insured group. This disparity, combined with the observed trend of older age at, and therefore likely delay of, CD diagnosis may contribute to a more rapid and severe CD course, ultimately leading to a shorter diagnosis-to-surgery interval. This study was limited by a small, single-center population sample, as well as other confounding factors associated with lack of insurance. Future research will include multivariate analysis to identify specific discrepancies in annual healthcare utilization between these populations, evaluate the contribution of race and language to this issue, and investigate the role that a decreased delay in diagnosis could play in preventing last resort proctectomy.



Disclosures:


Yonatan Israel, BS¹, Vladislav Izda, BS¹, Regina Longley, BA¹, Monica Feeley, BA¹, Esther Kim, BS¹, Cecilia Katzenstein, BA¹, Nikhil Maheshwari, BS¹, Patricia Sylla, MD², Sergey Khaitov, MD², Alexander Greenstein, MD, MPH², Serre-yu Wong, MD, PhD². P0197 - Decreased Healthcare Utilization in Uninsured Patients With Perianal Crohn’s Disease Undergoing Proctectomy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.