Investigation of Geospatial Disparities in Chronic Pancreatitis Outcomes.

OBJECTIVES

Chronic pancreatitis (CP) is a fibro-inflammatory disorder characterized by abdominal pain and pancreatic insufficiency resulting in significant morbidity. This study evaluates the impact of geospatial parameters assessed using the Social Vulnerability Index (SVI) on CP outcomes.

MATERIALS AND METHODS

We retrospectively analyzed CP patients with available addresses followed at our pancreas center. We reviewed demographics, number of CP flares, local complications, healthcare-resource utilization, and outpatient opioid prescriptions. Regression analysis was performed to assess the association between outcomes and SVI (divided into 4 quartiles [I-IV; IV being most vulnerable]).

RESULTS

Among 324 CP patients followed over 8 years, we noted trends of higher dependence on governmental insurance or no insurance among patients in higher SVI quartiles (III/IV vs I/II) but no differences in demographics, comorbidities, or etiology of CP. Among patients in higher SVI quartiles, we noted significantly higher frequency of hospitalizations for CP flares and reduced opioid use. Rates of exocrine and endocrine pancreatic dysfunction and healthcare-resource utilization were similar across SVI quartiles.

CONCLUSIONS

Residence in the most vulnerable neighborhoods may be associated with reduced opioid use and more frequent CP flares, suggesting possible inadequate pain control in these patients. These findings should guide prospective investigation of the impact of geospatial social determinants of health in CP.