Gu Phillip, Clifford Eric, Gilman Andrew, Chang Christopher, Moss Elizabeth, Fudman David I, Kilgore Phillip, Cvek Urska, Trutschl Marjan, Alexander J Steven, Burstein Ezra, Boktor Moheb
Division of Digestive and Liver Diseases, UT Southwestern, Dallas, TX 75390, USA.
Department of Computer Science, Louisiana State University, Shreveport, LA 71103, USA.
Pathophysiology. 2022 Jul 18;29(3):383-393. doi: 10.3390/pathophysiology29030030.
Low socioeconomic status (SES) is associated with greater morbidity and increased healthcare resource utilization (HRU) in IBD. We examined whether a financial assistance program (FAP) to improve healthcare access affected outcomes and HRU in a cohort of indigent IBD patients requiring biologics. IBD patients (>18 years) receiving care at a ‘safety-net’ hospital who initiated biologics as outpatients between 1 January 2010 and 1 January 2019 were included. Patients were divided by FAP status. Patients without FAP had Medicare, Medicaid, or commercial insurance. Primary outcomes were steroid-free clinical remission at 6 and 12 months. Secondary outcomes were surgery, hospitalization, and ED utilization. Multivariate logistic regression was used to calculate odds ratio (OR) and 95% confidence interval (CI). Decision tree analysis (DTA) was also performed. We included 204 patients with 258 new biologic prescriptions. FAP patients had less complex Crohn’s disease (50.7% vs. 70%, p = 0.033) than non-FAP patients. FAP records indicated fewer prior surgeries (19.6% vs. 38.4% p = 0.003). There were no statistically significant differences in remission rates, disease duration, or days between prescription and receipt of biologics. In multivariable logistic regression, adjusting for baseline demographics and disease severity variables, FAP patients were less likely to undergo surgery (OR: 0.28, 95% CI [0.08−0.91], p = 0.034). DTA suggests that imaging utilization may shed light on surgical differences. We found FAP enrollment was associated with fewer surgeries in a cohort of indigent IBD patients requiring biologics. Further studies are needed to identify interventions to address healthcare disparities in IBD.
社会经济地位低下（SES）与炎症性肠病（IBD）的更高发病率和医疗资源利用率（HRU）增加相关。我们研究了一项旨在改善医疗服务可及性的经济援助计划（FAP）是否会影响一组需要生物制剂的贫困IBD患者的治疗结果和HRU。纳入了2010年1月1日至2019年1月1日期间在一家“安全网”医院接受护理并作为门诊患者开始使用生物制剂的18岁以上IBD患者。患者按FAP状态分组。没有FAP的患者拥有医疗保险、医疗补助或商业保险。主要结局是6个月和12个月时无类固醇临床缓解。次要结局是手术、住院和急诊就诊。采用多变量逻辑回归计算比值比（OR）和95%置信区间（CI）。还进行了决策树分析（DTA）。我们纳入了204例患者，有258份新的生物制剂处方。FAP患者的克罗恩病复杂性低于非FAP患者（50.7%对70%，p = 0.033）。FAP记录显示既往手术较少（19.6%对38.4%，p = 0.003）。缓解率、疾病持续时间或生物制剂处方与用药之间的天数无统计学显著差异。在多变量逻辑回归中，调整基线人口统计学和疾病严重程度变量后，FAP患者接受手术的可能性较小（OR：0.28，95% CI [0.08 - 0.91]，p = 0.034）。DTA表明影像学利用可能有助于揭示手术差异。我们发现，在一组需要生物制剂的贫困IBD患者中，参加FAP与较少的手术相关。需要进一步研究以确定解决IBD医疗保健差异的干预措施。
