Document resource
Introduction Socioeconomic status (SES) has been associated with multiple negative healthcare variables that may impact prognosis in IBD, including reduced access to healthcare and adverse lifestyle factors. In this study, we sought to evaluate the impact of SES upon disease course in a tertiary hospital cohort, hypothesising that socioeconomic disadvantage might lead to increased disease severity reflected by a decreased time to first advanced therapy (AT).Methods We performed a retrospective cohort study of all patients with a diagnosis of IBD in the Cambridge University Hospitals electronic medical record. Socioeconomic disadvantage was quantified based upon the residential postal code, using the UK Index of Multiple Deprivation (IMD). The primary outcome was the association between time to first AT (Adalimumab, Golimumab, Infliximab, Ustekinumab, Vedolizumab or Tofacitinib) and IMD decile assessed using the Cox-proportional hazards regression method. Date of data extraction was used as the censor date. Survival curves were generated using the Kaplan-Meier method. Analysis was performed using R Studio.Results After filtering for data completeness, 4059 patients were identified for inclusion. 51.3% were female with a mean age of diagnosis of 32.7 (SD 16) years. 49.1% had ulcerative colitis (n = 1991), 46.5% Crohn’s disease (n = 1889) and 4.4% IBD-U (n =179). 30.3% (n = 1229) had started an AT by the time of censoring. The cohort was relatively socioeconomically advantaged with 27.2% (n = 1105) being in the top decile of SES score; nonetheless, 12.2% (n = 492) were also in the lowest 5 deciles. Univariate analysis demonstrated that higher SES deciles (representing lower deprivation scores) were associated with longer time to first AT, with a hazard ratio of 0.953 per one-decile increase in IMD (95% CI 0.927–0.98, p = 0.000810). In a multivariate analysis adjusting for age at diagnosis and disease subtype, decreasing social deprivation remained associated (HR 0.964, 95% CI 0.937 to 0.992, p = 0.011) as outlined in table 1. A sensitivity analysis with era-stratified models (diagnosis <2005 vs ≥ 2005) reflecting availability of biologics demonstrated comparable effects.Conclusions Socioeconomic deprivation as quantified by the IMD appears to increase disease severity at time of diagnosis as quantified by a decrease in time to first AT. Further research is required to identify and address the contributing factors behind this association and improve outcomes of this underserved population.Abstract P206 Table 1Multivariate cox proportional hazards model for time to first advanced therapyPredictorHR95% CIp-valueNational IMD decile (per 1↑ = less deprived)0.9640.937 – 0.9920.011Age at diagnosis (per year)0.9910.987 – 0.9952.1×10-5Crohn’s disease vs UC2.642.32 – 2.99< 2×10-16IBD-U vs UC1.641.18 – 2.270.00286