Investigation of the Association of Acute Pancreatitis Outcomes with Social Vulnerability Indicators - 23/01/25

Doi : 10.1016/j.amjmed.2024.12.026

Ankit Chhoda, MD ^a,^{^{#
Contributed equally to this manuscript.}}, Anabel Liyen Cartelle, MD ^b,^{^{#
Contributed equally to this manuscript.}}, Matthew Antony Manoj ^a, Marco Noriega, MD ^a, Kelsey Anderson, MD ^b, Shaharyar A. Zuberi, MD ^b, Alana Sur, BS ^a, Miriam Olivares, PhD ^c, Jill Kelly, PhD ^d, Steven D. Freedman, MD, PhD ^a, Loren Galler Rabinowitz, MD ^a, Sunil G. Sheth, MD, AGAF, FASGE, FACG ^a,^⁎
^a Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
^b Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
^c Geographical Information System Library, Yale University, New Haven, Conn
^d Yale School of Public Health, Yale University, New Haven, Conn

^⁎Requests for reprints should be addressed to Sunil G. Sheth, MD, AGAF, FASGE, FACG, Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Rabb 423, Boston, MA 02215.Department of Medicine, Division of GastroenterologyBeth Israel Deaconess Medical Center, Harvard Medical School330 Brookline Ave, Rabb 423BostonMA02215

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Thursday 23 January 2025

Abstract

Background and Aim

Geospatial analyses integrate location-based sociodemographic data, offering a promising approach to investigate the impact of social determinants on acute pancreatitis outcomes. This study aimed to examine the association of Social Vulnerability Index (SVI) and its constituent 16 attributes in 4 domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation), with outcomes in patients with acute pancreatitis.

Methods

This study included acute pancreatitis patients hospitalized between 1/1/2008 and 12/31/2021 and recorded their demographics and clinical outcomes. Physical addresses were geocoded to determine SVI, a composite variable which was ranked and divided into quartiles (I-IV: IV representing the highest vulnerability).

Result

In 824 eligible patients [age of 53.0 ± 10 years and 48.2% females], with 993 acute pancreatitis-related hospitalizations, we noted a significant association in patients residing in communities with higher SVI, a higher prevalence of no/federal/state insurance (P < .001) and underserved ethnic/racial background (P < .001). We observed a significant association of alcohol withdrawal in patients with residence in areas with higher SVI despite adjustment for age, body mass index, and comorbidities (odds ratios: 1.62 [95% CI: 1.19-2.22]; P = .003). However, we observed no association of SVI with severity of acute pancreatitis, inpatient opioid use, length of stay, 30-day admission rate, and mortality.

Conclusions

We noted significantly higher alcohol withdrawal in patients residing in areas with higher SVI ranks, despite no differences in severity of acute pancreatitis, inpatient opioid use, length of stay, 30-day admission rate, and mortality.

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Keywords : Acute pancreatitis, Alcohol withdrawal, Geospatial disparity

Esquema

Introduction

Methods

Study Design and Setting

Study Population

Variable Definitions

Geocoding and SVI Estimation

Statistical Analysis

Results

Patient Characteristics

Clinical Course and Management

Disposition Outcome

Regression Analysis

Discussion

	Funding: None.
	Conflict of Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article.
	Authorship: AC performed the research, AC, ALC, KA, SZ, and AS collected and analyzed the data, AC and SGS designed the research study, AC, ALC, and MAM wrote the paper, MO, JK, SF and LR contributed to the design of the study. SGS supervised the entire project.