Health-Related Social Needs & Disease Activity Are Independently Associated With Moderate-to-Severe IBD-Related Disability

Introduction: IBD impacts an individual’s education and employment participation, economic and social activities, and physical and psychosocial function – a concept encapsulated as ‘IBD-related disability’. We aim to identify disease- and patient-related factors, including health-related social needs, associated with IBD-related disability. Methods: We surveyed adults with IBD at 3 GI practices (2 academic centers; 1 private community practice) from Feb-Apr 2023. To identify patient/disease factors associated with moderate-to-severe IBD-related disability (vs. no/low disability, measured by the IBD Disability Index), we used Wilcoxon rank sum or χ2 tests and logistic regression models with variables determined a priori: gender, age, IBD subtype, IBD disease activity (2-item patient-reported outcome, PRO-2), IBD knowledge (Crohn’s and Colitis Knowledge Score), and health-related social needs across 4 domains of housing instability, food security, transportation needs, and utility needs (Centers for Medicare & Medicaid Services Health-Related Social Needs Screening Tool). Results: Of the 239 adults with IBD surveyed (63% CD, 37% UC; 79% active, 21% remission; median age 36 years; 58% female; 85% White, 9% Black; 87% post-secondary education; 80% working/studying; 61% married), nearly half (44%) had moderate-to-severe IBD-related disability (Table 1). Over one-fifth (23%) of patients have at least one health-related social need (mean 0.4, 95% CI 0.3-0.5); poor housing quality (12%) and food insecurity (9%) were the most common. On multivariable analysis, active disease (aOR 6.3, 95% CI 2.1-10.3) and health-related social needs (any vs. none: aOR 7.3, 95% CI 3.4-16.0) were independently associated with moderate-to-severe IBD-related disability, but gender, age, IBD subtype, and IBD-specific knowledge were not (Figure 1). The presence of each health-related social need was associated with a 3-fold increased risk for moderate-to-severe IBD-related disability (aOR 3.1, 95% CI 1.8-5.3). Conclusion: IBD disease activity and health-related social needs are independently associated with IBD-related disability. Housing instability and food insecurity are independently associated with a 3-fold risk for IBD-related disability. Pharmacologic IBD-directed therapies to reduce disease activity and non-pharmacologic interventions that target social determinants of health are both necessary for a holistic approach to IBD care to reduce the overall burden of IBD disability. Table 1. - Patient Demographics and Disease Characteristics Patient/Disease Characteristics All No/Low IBD-Related Disability Moderate-to-Severe IBD-Related Disability P-value Demographics Age, median (IQR), year 36.0 (31.0-50.0) 36.0 (31.0-51.5) 37.0 (31.0-49.0) 0.602 Gender, n (%), missing n=17 Male 93 (41.9) 54 (43.6) 39 (39.8) 0.574 Female 129 (58.1) 70 (56.4) 59 (60.2) Race/Ethnicity, n (%), missing n=28 Non-Hispanic White 179 (84.8) 105 (87.5) 74 (81.3) 0.586 Non-Hispanic Black 19 (9.0) 9 (7.5) 10 (11.0) Hispanic 7 (3.3) 3 (2.5) 4 (4.4) American Indian or Alaska Native 0 0 0 Asian/Hawaiian/Pacific islander 5 (2.4) 3(2.5) 2(2.2) others/unknown 1 (0.5) 0 1 (1.1) Marital Status, n (%) Married/partnered 133 (60.7) 83 (67.0) 50 (52.6) 0.190 Not married 69 (31.5) 33 (26.6) 36 (37.9) Divorced 12 (5.5) 6 (4.8) 6 (6.3) Widowed 5 (2.3) 2 (1.6) 3 (3.2) Education Attainment, n (%), missing n=16 No education 0 0 0 0.056 Elementary School 0 0 0 High School Diploma 29 (13.3) 13 (10.5) 16 (16.2) Sub-bachelor or Vocational Diploma or Certificate 9 (4.0) 2 (1.6) 7 (7.1) Associate Degree 11 (4.9) 5 (4.0) 6 (6.1) Bachelor’s Degree 73 (32.7) 39 (31.5) 34 (.4.3) First Professional Degree 1 (0.4) 0 1 (1.0) Post-bachelor's Diploma/Certificate 4 (1.7) 4 (3.2) 0 Master’s Degree 62 (27.8) 38 (30.7) 24 (24.2) Doctorate or Advanced Professional Degree 33 (14.8) 23 (18.5) 10 (10.1) other 1 (0.4) 0 1 (1.0) Work, n (%), missing n=16 Study at school 18 (8.1) 9 (7.3) 9 (9.1) 0.010 Paid employment 141 (63.2) 86 (69.4) 55 (55.6) Self-employed 19 (8.5) 8 (6.4) 11 (11.1) Housewife/househusband 5 (2.2) 4 (3.2) 1 (1.0) Unemployed 7 (3.1) 2 (1.6) 5 (5.0) Disabled 12 (5.4) 1 (0.8) 11 (11.1) Retired 18 (8.1) 12 (9.7) 6 (6.1) Something else 3 (1.4) 2 (1.6) 1 (1.0) IBD Characteristics IBD Subtype, n (%) Crohn’s disease 150 (62.8) 74 (55.6) 76 (71.7) 0.011 Ulcerative colitis 89 (37.2) 59 (44.4) 30 (28.3) IBD Disease Activity*, n (%) Active 188 (79.0) 92 (69.2) 96 (91.4) < 0.001 Remission 50 (21.0) 41 (30.8) 9 (8.6) Urgency (Likert scale 0-10), median (IQR) 2 (1-6) 2 (1-3) 6 (3-7) < 0.001 IBD-Related Knowledge Score, (range 0-24) 13.0 (8.0-16.0) 12.0 (8.0-16.0) 13.0 (9.0-15.5) 0.762 IBD-Related Disability, n (%) None 64 (26.8) 64 (48.1) 0 - Mild 69 (28.9) 69 (51.9) 0 Moderate 66 (27.6) 0 66 (62.3) Severe 40 (16.7) 0 40 (37.7) Health-Related Social Needs, missing n=6 Number of social needs, mean (95% CI) 0.39 (0.28-0.51) 0.14 (0.06-0.23) 0.72 (0.49-0.94) < 0.001 0 181 (77.4) 120 (90.9) 61 (59.8) < 0.001 1 30 (12.8) 7 (5.3) 23 (22.5) 2 14 (6.0) 3 (2.3) 11 (10.8) 3 6 (2.6) 2 (1.5) 4 (3.9) 4 0 0 0 5 2 (0.8) 0 2 (2.0) 6 1 (0.4) 0 1 (1.0) Any Social Needs No 181 (75.7) 120 (90.2) 61 (57.5) < 0.001 Yes 58 (24.3) 13 (9.8) 45 (42.5) Housing instability 13 (5.6) 1 (0.8) 12 (11.8) < 0.001 Por housing quality 27 (11.5) 6 (4.6) 21 (20.6) < 0.001 Food insecurity (worry) 20 (8.6) 6 (4.6) 14 (13.7) 0.013 Food shortage (ran out of food) 14 (6.0) 4 (3.0) 10 (10.0) 0.030 Transportation Needs 12 (5.1) 1 (0.8) 11 (10.8) 0.001 Utility Needs 6 (2.6) 1 (0.8) 5 (4.9) 0.047 Abbreviations: IBD; inflammatory bowel diseases; IQR, interquartile range.*IBD remission was defined using the 2-item patient-reported outcome measure (PRO-2) for stool frequency (SF), abdominal pain (AP), and rectal bleeding (RB): SF=0/RB=0 for ulcerative colitis (UC) and SF≤3/AP≤1 for Crohn’s disease (CD). Figure 1.: Multivariate Logistic Regression of Patient and Disease Factors Associated with Moderate-to-Severe IBD-Related Disability Abbreviations: aOR, adjusted odds ratio; CD, Crohn’s disease; CI, confidence interval; IBD, inflammatory bowel diseases; UC, ulcerative colitis.