Socioeconomic disparities in biologic persistence among patients with inflammatory bowel disease are associated with increased health care utilization.

INTRODUCTION

Biologic persistence, defined as the total uninterrupted time on a biologic agent, is associated with improved outcomes in inflammatory bowel disease (IBD). However, social determinants of health (SDOH), such as socioeconomic status, may influence a patient's ability to access these medications. We aimed to better understand the relationship between socioeconomic status and biologic persistence in patients with IBD and to determine whether patients with poor biologic persistence had higher health care utilization.

METHODS

We identified patients with IBD seen at the University of Michigan during 2015-2022. Using the Centers for Disease Control Social Vulnerability Index (SVI), we examined the relationship between socioeconomic status and biologic persistence, defined as an active biologic prescription for 365 days or longer, while controlling a priori for IBD type, age, sex, race, comorbidities, IBD severity, and insurance type. Secondarily, we examined the relationship between biologic persistence and unplanned health care utilization.

RESULTS

In this cohort of 3067 patients with IBD who were prescribed biologics, 20% (n = 620) did not achieve biologic persistence. Low socioeconomic status (odds ratio [OR] 0.56; P = .003) was associated with a lower likelihood of achieving biologic persistence. Biologic persistence was associated with lower risk of IBD-related hospitalization (incidence rate ratio [IRR], 0.48; P < .001), readmission (IRR, 0.52; P < .001), and surgery (IRR, 0.33; P < .001).

CONCLUSIONS

Low socioeconomic status was associated with lower likelihood of biologic persistence and patients who lacked biologic persistence had greater IBD-related unplanned health care utilization.