P055 Sociodemographic Differences in Fecal Enteropathogen Testing Patterns in Adults Hospitalized for Inflammatory Bowel Disease Flares.

BACKGROUND

Adults with inflammatory bowel disease (IBD) have increased risks for gastrointestinal infections. Single-center studies in Michigan and New York report 17-31% positive enteropathogen tests in patients with symptomatic IBD. Population-based studies are lacking, particularly on factors that determine who undergo testing. Health inequities may exist in the care of patients with IBD where certain groups systematically experience social and/or economic disparities. We aim to assess sociodemographic and healthcare factors associated with enteropathogen testing of hospitalized IBD patients.

METHODS

In this retrospective cohort study, we identified 770 patients with IBD who had 1,189 hospital admissions for primary symptoms consistent with IBD flares/enteric infections at 3 hospitals (tertiary referral teaching, community, and county) in the largest healthcare system in Rhode Island from January 2017-March 2019. Using modified Poisson regression to estimate relative risks (RR) and 95% Confidence Intervals (CIs), we assessed enteropathogen testing status as a function of sociodemographic and clinical characteristics in separate models.

RESULTS

Patients with IBD hospitalized with symptoms consistent with IBD flares or enteric infections disproportionately had Crohn's disease (69% vs. 31% UC). Patients were 47 years old on average, 60% women, 79% non-Hispanic white, 13% Hispanic, and 7% non-Hispanic Black. Over half (55%) were privately insured, 42% publicly insured, and 2% uninsured. Over half (55%) of patients were treated with glucocorticoids within 1 week of hospitalization while 35% were on biologics. The top 5 primary symptoms for hospitalization were abdominal pain (63%), GI bleeding (8%), fever (8%), vomiting (7%), and diarrhea (7%). Enteropathogen testing (may be >1) was obtained in 46% of hospitalizations: 42% tested for C. difficile; 23 % tested for Salmonella spp., Shigella spp./enteroinvasive E. coli, Campylobacter spp., and Shiga toxin-producing organisms; and 15% had extensive testing for 22 enteropathogens (13 bacteria, 5 viruses, and 4 parasites). 10% of the tests were positive, most commonly for C. difficile (5%), E. coli spp (0.6%), Campylobacter spp (0.5%), Salmonella (0.3%), and Norovirus (0.3%). While gender differences in testing were not observed (female 45%, male 46%, F:M, RR 1.01, 95% CI 0.90,1.15), Hispanic patients were more likely to undergo enteropathogen testing than non-Hispanic white patients (58% vs 44%; RR 1.21, 95% CI 1.02-1.43). Relative to patients hospitalized at the tertiary referral teaching hospital, patients at the county hospital were 29% less likely (95% CI, 0.54-0.93) and those at the community hospital were 22% (95% CI 0.78-1.01) less likely to have enteropathogen testing. Enteropathogen testing occurred most frequently among the privately insured 48%, while uninsured were comparatively 20% less likely and publicly insured were 10% less likely to undergo testing, though neither comparison was statistically significant.

CONCLUSION

Racial/ethnic (Hispanic vs non-Hispanic White) and healthcare settings (county vs tertiary referral teaching hospital) differences in enteropathogen testing patterns were observed in adults with IBD hospitalized primarily for GI symptoms at the state of Rhode Island's largest healthcare system. Further studies to assess health inequities, including sociodemographic and organizational differences, in the healthcare delivery in IBD are warranted.