Pediatric inflammatory bowel disease patients from vulnerable areas have delayed remission and more hospitalizations.

OBJECTIVES

Pediatric inflammatory bowel disease (IBD) has a rising incidence. While the underlying etiology is not fully understood, genetics and environmental factors are known to play a role. Social determinants of health (SDoH) also play a role in worsening morbidity and mortality for chronic diseases. This study evaluated the association between SDoH and pediatric IBD, hypothesizing that individuals residing in more socially vulnerable areas will have worse outcomes during the first year of diagnosis.

METHODS

This retrospective cohort study included 222 patients diagnosed with IBD at Children's of Alabama from 2018 to 2022. The social vulnerability index (SVI) was used to quantify neighborhood-level socioeconomic vulnerability. Primary outcomes were hospitalization at diagnosis, hospitalization during the first year, disease activity at 6 months, and persistent disease activity at 1 year.

RESULTS

Patients from neighborhoods in the most socioeconomically vulnerable quartile (top 25% of SVI) were more likely to be hospitalized at diagnosis (adjusted odds ratio [aOR] 2.51, p = 0.028), more likely to be hospitalized during the first year (aOR 3.44, p = 0.031), and more likely to have active disease at 6 months (unadjusted OR 2.47, p = 0.016) compared to those from neighborhoods in the least vulnerable quartile. However, there were no significant differences by neighborhood socioeconomic vulnerability in active disease at 1 year.

CONCLUSION

Social vulnerability contributes to increased risk of hospitalization and delays in achieving remission during the first year after new diagnosis of IBD. This finding highlights the importance of SDoH screening to identify at-risk patients at the time of diagnosis to guide targeted interventions and prevent worse disease outcomes.