Madalina Butnariu, MD1, Kyle Porter, MAS2, Syed Husain, MD1, Anita Afzali, MD, MPH, FACG1
1The Ohio State University Wexner Medical Center, Columbus, OH; 2The Ohio State University, Columbus, OH
Introduction: Morbid obesity (MO) is increasingly more common among patients with inflammatory bowel disease (IBD). Prior studies describe a complex interplay between the proinflammatory state associated with obesity and IBD. Type 2 diabetes (T2D) patients are also at risk for poorer outcomes and additional healthcare costs. The clinical implications of obese, diabetic IBD patients are not well described. We conducted a nationally representative cohort study to estimate and compare the burden, costs and causes for hospitalizations and readmissions among IBD patients with or without diabetes and obesity.
Methods: Using the Nationwide Readmissions Database (NRD) 2010-2014, IBD patients were categorized into 4 groups: T2D and MO; MO alone; T2D alone; no-T2D and no-MO. A 1:1 propensity score was performed for each group matching to patients with both T2D and MO. Linear regression was used to compare rates of hospital days, total costs, and number of hospital admissions among the 4 groups. Outcomes were log-transformed for analysis to better meet normality assumptions, as each was right-skewed. Calendar year mortality were compared between groups by logistic regression.
Results: There were 8,526 IBD patients with T2D and MO; MO alone (n=12,512); T2D alone (75,269); and no-MO and no-T2D (466,508). After propensity score matching, the mean number of hospital days per year (13.9 days, 95% CI 13.2-14.7) and mean cost per year ($32,709, 95% CI 30,937-34,582) were higher in the T2D and MO group compared to other groups (p<.001). Mean number of admissions per year was higher in the T2D and MO group (2.88, 95% CI 2.77-2.99) compared to MO only group (2.70, 2.58-2.82) (p< .05). T2D and MO were more likely than other groups to have infection- and respiratory-related readmissions (p< .001); and more likely than no-T2D/no-MO to have IBD-specific (p=0.01) or cerebrovascular readmissions (p=.004).T2D patients were more likely than MO only or no-T2D/no-MO for cardiac-related readmissions (p< .001).There were no differences in mortality among the four groups.
Discussion: Our NRD analysis demonstrates that diabetic, obese IBD patients have higher burden and costs of hospitalizations. Improved strategies and preventative care efforts for tighter glycemic control and weight loss are needed to target this high-risk group of patients with IBD.
Citation: Madalina Butnariu, MD; Kyle Porter, MAS; Syed Husain, MD; Anita Afzali, MD, MPH, FACG. P0470 - INFLAMMATORY BOWEL DISEASE PATIENTS WITH TYPE 2 DIABETES AND OBESITY HAVE A HIGHER ANNUAL BURDEN AND COSTS OF HOSPITALIZATIONS: A CALL FOR ACTION. Program No. P0470. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.