Damas Oriana M, Kuftinec Gabriela, Khakoo Nidah S, Morillo Diana, Quintero Maria A, Levitt James, Lopez Joanna, Kerman David H, Abreu Maria T, Deshpande Amar R, Schwartz Seth J, Palacio Ana
Assistant Professor, Director of Translational Studies for the Crohn's and Colitis Center and Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine Clinical Research Building, 1120 NW 14th Street CRB 971, Miami, FL, 33136 USA.
Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Therap Adv Gastroenterol. 2022 Mar 24;15:17562848221079162. doi: 10.1177/17562848221079162. eCollection 2022.
The impact of social determinants of health in inflammatory bowel disease (IBD) remains understudied. We evaluated the impact of social barriers on IBD outcomes within a diverse cohort of patients.
We performed a cross-sectional study on adult IBD patients and assessed known social determinants of health. We calculated the total prevalence of these barriers in the sample as a whole and within each ethnic group. We summed the number of barriers present for each individual to create a cumulative social barrier score (SBS), and we evaluated the relationship of each barrier and of the cumulative SBS with IBD outcomes, including disease activity and depressive symptoms.
A total of 316 patients were included in the study. Disparities in the prevalence of social barriers emerged by ethnicity: non-Hispanic Blacks reported the greatest number of social barriers, followed by Hispanic patients. Prevalent social barriers included financial strains (38.4%), such as food insecurity, medical care delays (~30%), and low educational attainment (26.8%). Social barriers associated with poor IBD outcomes included low educational attainment, poor health literacy, and financial insecurity. High SBS was associated with greater depressive symptoms [odds ratio (OR) 1.94, 95% confidence interval (CI) 1.21-2.9, = 0.001] and lower reported use of medications. Greater ulcerative colitis (UC) disease activity was observed in patients with greater SBS. No associations were identified between SBS and IBD surgeries, hospitalizations, or disease location.
Our study identifies social barriers that may impact IBD care and are disproportionately higher in non-Hispanic Blacks and Hispanics in the United States. Future studies should focus on implementing interventions to reduce these barriers and improve delivery of care.
健康的社会决定因素对炎症性肠病（IBD）的影响仍未得到充分研究。我们评估了社会障碍对不同患者群体中IBD结局的影响。
我们对成年IBD患者进行了一项横断面研究，并评估了已知的健康社会决定因素。我们计算了这些障碍在整个样本以及每个种族群体中的总患病率。我们汇总了每个个体存在的障碍数量，以创建累积社会障碍评分（SBS），并评估了每个障碍以及累积SBS与IBD结局（包括疾病活动和抑郁症状）之间的关系。
共有316名患者纳入研究。社会障碍的患病率因种族而异：非西班牙裔黑人报告的社会障碍数量最多，其次是西班牙裔患者。常见的社会障碍包括经济压力（38.4%），如粮食不安全、医疗延误（约30%）和低教育程度（26.8%）。与不良IBD结局相关的社会障碍包括低教育程度、健康素养差和经济不安全。高SBS与更严重的抑郁症状相关[比值比（OR）1.94，95%置信区间（CI）1.21 - 2.9，P = 0.001]，且报告的药物使用量较低。在SBS较高的患者中观察到更高的溃疡性结肠炎（UC）疾病活动度。未发现SBS与IBD手术、住院或疾病部位之间存在关联。
我们的研究确定了可能影响IBD护理的社会障碍，在美国非西班牙裔黑人和西班牙裔中这些障碍的比例尤其高。未来的研究应侧重于实施干预措施以减少这些障碍并改善护理服务。
