DDW 2021: Epidemiology & Natural History of IBD
The Digestive Disease Week virtual conference kickstarted on Friday, May 21, 2021, with 5 societies (AASLD, AGA, ASGE, DDW, SSAT) taking part and over 15 different tracks. In the Inflammatory Bowel Diseases track, I joined the Epidemiology & Natural History of IBD session. Dr. Sunanda V. Kane, from Mayo Clinic, Rochester MN, opened the session, with the aim to understand how Inflammatory Bowel Diseases (IBD) are distributed through race, ethnicity and gender in the United States. The session hosted six speakers, covering the following sessions:
Session #1: Dr. Edward Lee Barnes – RACIAL AND ETHNIC DISTRIBUTION OF INFLAMMATORY BOWEL DISEASE IN THE UNITED STATES
This study used PCORnet (National Clinical Research Network) data as well as US Census data (2015).
Through this study, we learnt that:
Adult and pediatric patients with Crohn’s Disease (CD) or Ulcerative Colitis (UC) are more likely to be White and non-Hispanic.
Both adult and pediatric populations of Black/African American and Hispanic ethnicity are less likely to have a diagnosis of CD or UC as compared to White patients.
Comparing adult to pediatric populations, across race, shows that IBD diagnoses is rising among non-White populations, while staying more or less constant for White populations.
For drawing further inferences, it is important to conduct more research on health equity patterns among IBD patients, with an improved understanding of the demographics and epidemiology of these varied IBD patients.
Session #2: Dr. Fernando Velayos – PREDNISONE, BUT NOT BIOLOGICS OR IMMUNOMODULATORS ARE ASSOCIATED WITH SEVERE COVID-19 OUTCOMES: A COMMUNITY BASED STUDY
IBD management includes a series of immune-system-altering medications. In the context of COVID-19, this study sought to find out whether certain management techniques/medications put IBD patients at a greater risk for developing severe COVID-19 outcomes.
This study suggested:
The use of oral prednisone prior to SARS-CoV-2 diagnoses, is associated with hospitalization, ICU admission, and death. Thus, during the pandemic, doctors are advised to minimize outpatient steroid use where possible.
Immunomodulators and biologics are not associated with severe COVID-19 outcomes.
IBD is not an independent risk factor for severe COVID-19 outcomes.
Session #3: Dr. Mehwish Ahmed – CROHN’S DISEASE, ANXIETY AND DEPRESSION, AND BASELINE C-REACTIVE PROTEIN LEVEL PREDICT RISK FOR INCIDENT IRRITABLE BOWEL SYNDROME-LIKE SYMPTOMS IN QUIESCENT INFLAMMATORY BOWEL DISEASE
Approximately 41% of patients with inactive IBD report having IBS-like symptoms, leading to a lower quality of life. This study aimed to identify risk factors associated with IBD-like symptoms in patients with inactive IBD.
The study suggested:
Those with moderate to heavy alcohol use, comorbid anxiety or depression, use of psychotropic medications, increased C-reactive protein and the presence of rheumatologic intestinal manifestations are at higher risk for developing IBS-like symptoms.
Crohn’s disease, comorbid anxiety or depression, and increased CRP levels are independent risk factors.
Confirmatory data is required for further analysis.
Session #4: Dr. Mohamed Tausif Siddiqui – PREVALENCE AND OUTCOMES OF ALCOHOL USE DISORDERS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Alcohol has always been a potential trigger for IBD. However, more than half of the total number of patients with CD or UC, who identify as current drinkers, are moderate or heavy drinkers. This study sought to find out whether Alcohol Use Disorder (AUD) is associated with in-hospital mortality, keeping age, gender and ethnic trends in mind.
This study observed:
Irrespective of CD or UC, IBD in general, is affected by AUD, causing in-hospital mortality.
The risk factors associated with AUD are: (1) Age bracket [51-65], (2) Gender [Male], Race [Caucasian].
Session #5: Dr. Poonam Beniwal-Patel – RACIAL AND GENDER DISPARITIES EXIST IN INFLUENZA VACCINATION RATES AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE
Patients with IBD are observed to have overall lower vaccination rates than the general population and are associated with an increased risk of infection, especially vaccine-preventable diseases (VPD). This study determined if disparities in race or ethnicity exist within immunization rates of patients with IBD.
The findings were:
Black patients had significantly lower rates than white patients for influenza vaccinations.
Female patients had significantly higher rates than their male counterparts for influenza vaccinations.
Future studies can assess the causes for these disparities, and advise on strategies to combat vaccine hesitancy. In the context of COVID-19, this research will be especially important for IBD patients.
Session #6: Dr. Chung Sang Tse – LOW HEALTH CONFIDENCE IS ASSOCIATED WITH SIGNIFICANTLY MORE HOSPITAL-BASED, ACUTE HEALTHCARE UTILIZATION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: A NATIONAL SAMPLE OF OVER 18,000 ADULTS
Patient engagement and activation with regards to their health is a growing concern for positive engagement with healthy lifestyle choices and lessened emergency department (ED) visits and hospitalizations. Health Confidence is a proxy measure for this and is influenced by a multitude of factors, including personal beliefs, socioeconomic status, health literacy and disease specific knowledge.
This study showed that
The health confidence of patients who had an ED visit or hospitalization were lower than those without an ED visit or hospitalization.
A health confidence score of 7 (range 0-11 on Likert scale) appeared to be an inflection point for ED visits and hospitalizations, and thus for score less than 7, they should be considered at increased risk for the same.
Health confidence was not different between UC or CD patients.
“Interventions that increase health confidence may reduce high-cost, acute healthcare utilization.”