Residence in Peripheral Regions and Low Socioeconomic Status Are Associated With Worse Outcomes of Inflammatory Bowel Diseases: A Nationwide Study From the epi-IIRN

Oren Ledder*, Sasha Harel, Rona Lujan, Chagit Friss, Esther Orlanski-Meyer, Dotan Yogev, Yiska Loewenberg Weisband, Shira Greenfeld, Revital Kariv, Natan Lederman, Eran Matz, Doron Schwartz, Gili Focht, Iris Dotan, Dan Turner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Timely access to quality medical care impacts patient outcomes in inflammatory bowel disease (IBD). In a nationwide study from the epidemiology group of the Israeli IBD research nucleus we aimed to assess the impact of residence and socioeconomic status (SES) on disease outcomes. Methods: We utilized data from the 4 health maintenance organizations in Israel, representing 98% of the population. Regions were defined as central, northern and southern; SES was graded from lowest to highest (from 1 to 4) as per Israel Central Bureau of Statistics. The primary outcome was steroid dependency, with secondary outcomes of surgeries and biologic therapy use. Results: A total of 28 216 IBD patients were included: 15 818 (56%) Crohn’s disease (CD) and 12 398 (44%) ulcerative colitis; 74%, 12% and 14% resided in central, southern, and northern Israel, respectively (SES 1: 21%, SES 4: 12%). Lower SES was associated with steroid dependency (20% in SES 1 vs 12% in SES 4 in CD; P < .001; and 18% vs 12% in ulcerative colitis; P < .001), and higher surgery rates (12% vs 7%; P < .001, and 1.4% vs 0.7%; P = .115, respectively). There were higher steroid dependency and CD surgery rates in peripheral vs central regions. In multivariable models, both SES and peripheral region were independently associated with poorer outcomes. Conclusions: We found that lower SES and peripheral residence were associated with deleterious outcomes in IBD. This should be considered by policymakers and should encourage strategies for improving outcomes in populations at risk.

Original languageAmerican English
Article numberizad034
JournalInflammatory Bowel Diseases
Volume30
Issue number1
DOIs
StatePublished - 5 Jan 2024

Bibliographical note

Publisher Copyright:
© 2024 Oxford University Press. All rights reserved.

Keywords

  • inflammatory bowel disease
  • medical access
  • socioeconomic status

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