Prevalence and Impact of Social Risk in Patients With Inflammatory Bowel Diseases: National Estimates from the United States.

Abstract

Background and aims: Social risks are individual-level factors associated with adverse health outcomes. We determined the prevalence and impact of social risks on healthcare use among patients with inflammatory bowel diseases (IBDs) in the United States.

Methods: In the U.S. National Health Interview Survey 2023, we estimated social risks across 6 domains (food insecurity, financial hardship, housing instability, transportation needs, education and employment, discrimination) in adults with IBD. We evaluated the association between burden of social risk (0 of 6 domains [none], 1 of 6 domains [mild], 2 of 6 domains [moderate], and ≥3 of 6 domains [severe]), unplanned healthcare utilization (emergency department and/or hospitalization), and medication nonadherence, accounting for differences in age, sex, race/ethnicity, insurance, income, and comorbidities.

Results: Of 572 people included in the survey (mean age 56 years; 57% female; 81% non-Hispanic White [NHW], 12.9% Hispanic), 64% (95% confidence interval [CI], 59%-69%) experienced social risk across 1 or more domains (food insecurity, 22%; financial hardship, 28%; housing instability, 14%; transportation needs, 9%; education and employment, 9%; discrimination, 41%). Prevalence of severe social risk was higher in racial and ethnic minority groups (non-Hispanic Black vs Hispanic vs NHW: 37% vs 28% vs 12%). A higher burden of social risk was associated with higher risk of unplanned healthcare utilization (severe vs none: odds ratio, 3.5; 95% CI, 1.2-10.2) and cost-related medication nonadherence (OR, 11.8; 95% CI, 2.7-52.1), after accounting for income and insurance status.

Conclusions: Social risks are prevalent in adults with IBD and negatively impact healthcare utilization and medication nonadherence. Efforts to routinely identify and address social risks in patients with IBD should be part of standard clinical care.