Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Manitoba, Winnipeg, Canada.
Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Am J Gastroenterol. 2020 Dec;115(12):2036-2046. doi: 10.14309/ajg.0000000000000794.
In a population-based inflammatory bowel disease (IBD) cohort, we aimed to determine whether having lower socioeconomic status (LSS) impacted on outcomes.
We identified all 9,298 Manitoba residents with IBD from April 1, 1995, to March 31, 2018 by applying a validated case definition to the Manitoba Health administrative database. We could identify all outpatient physician visits, hospitalizations, surgeries, intensive care unit admissions, and prescription medications. Their data were linked with 2 Manitoba databases, one identifying all persons who received Employment and Income Assistance and another identifying all persons with Child and Family Services contact. Area-level socioeconomic status was defined by a factor score incorporating average household income, single parent households, unemployment rate, and high school education rate. LSS was identified by any of ever being registered for Employment and Income Assistance or with Child and Family Services or being in the lowest area-level socioeconomic status quintile.
Comparing persons with LSS vs those without any markers of LSS, there were increased rates of annual outpatient physician visits (relative risk [RR] = 1.10, 95% confidence interval [CI] = 1.06-1.13), hospitalizations (RR = 1.38, 95% CI = 1.31-1.44), intensive care unit admission (RR = 1.94, 95% CI = 1.65-2.27), use of corticosteroids >2,000 mg/yr (RR = 1.12, 95% CI = 1.03-1.21), and death (hazard ratio 1.53, 95% CI = 1.36-1.73). Narcotics (RR = 2.17, 95% CI = 2.01-2.34) and psychotropic medication use (RR = 1.98, 95% CI = 1.84-2.13) were increased. The impact of LSS was greater for those with Crohn's disease than for those with ulcerative colitis.
LSS was associated with worse outcomes in persons with IBD. Social determinants of health at time of diagnosis should be highly considered and addressed.
在一项基于人群的炎症性肠病（IBD）队列研究中，我们旨在确定较低的社会经济地位（LSS）是否会影响结局。
我们通过将验证后的病例定义应用于曼尼托巴省的医疗管理数据库，确定了 1995 年 4 月 1 日至 2018 年 3 月 31 日期间所有 9298 名曼尼托巴居民患有 IBD。我们可以识别所有门诊医生就诊、住院、手术、重症监护病房入院和处方药。他们的数据与两个曼尼托巴数据库相关联，一个数据库确定了所有接受就业和收入援助的人，另一个数据库确定了所有与儿童和家庭服务有联系的人。通过纳入家庭平均收入、单亲家庭、失业率和高中学历率的因素评分来定义地区社会经济地位。LSS 通过以下任何一种情况来确定：曾经登记接受就业和收入援助或儿童和家庭服务，或处于最低地区社会经济地位五分位数。
与没有任何 LSS 标志物的人相比，LSS 患者的年门诊医生就诊次数（相对风险 [RR] = 1.10，95%置信区间 [CI] = 1.06-1.13）、住院（RR = 1.38，95% CI = 1.31-1.44）、重症监护病房入院（RR = 1.94，95% CI = 1.65-2.27）、使用皮质类固醇>2000mg/年（RR = 1.12，95% CI = 1.03-1.21）和死亡（风险比 1.53，95% CI = 1.36-1.73）的比率更高。阿片类药物（RR = 2.17，95% CI = 2.01-2.34）和精神药物的使用（RR = 1.98，95% CI = 1.84-2.13）也增加了。LSS 对克罗恩病患者的影响大于溃疡性结肠炎患者。
LSS 与 IBD 患者的不良结局相关。在诊断时，应高度考虑和解决健康的社会决定因素。
