S820 Health Disparities, Social Determinants of Health, and Emotional Impacts in Patients With Ulcerative Colitis: Results From a Global Ulcerative Colitis Patient Survey

Introduction: The UC Narrative global survey assessed various aspects of living with UC, including gaps in patient (pt) care and communication between pts and physicians. This analysis aimed to identify health disparities, social determinants of health, and emotional impacts related to UC disease management, healthcare experience, and overall quality of life. Methods: The UC Narrative survey was conducted by The Harris Poll (Aug 2017–Feb 2018). This analysis included 1,000 pts diagnosed with UC (confirmed by endoscopy) from the United States, Canada, Japan, France, and Finland (aged ≥ 18 years, no prior colectomy, had been to a gastroenterologist/internist’s office within the past year, and had ever taken UC prescription medication other than only aminosalicylates). Survey items were stratified by categories pertaining to pt demographics, access disparities, gaps in optimal care, mental health impacts, and the pt perspective. Data were analyzed and presented using logistic regression with odds ratios (ORs) and relative difference between groups. Results: Disparities related to sex (Table) and psychological comorbidities (Figure) impacted the pts’ healthcare experience and/or factors considered important for UC disease management. Low-income pts vs high-income pts were 70% (OR = 0.30) and 49% (OR = 0.51) less likely to have participated in a peer mentoring or a UC education program, respectively, and 48% less likely (OR = 0.52) to have reached out to pt associations or organizations. Pts with lower vs higher educational levels were 41% less likely (OR = 0.59) to have reached out to pt associations or organizations. Compared with pts employed full time, pts who were not employed were 89% less likely (OR = 0.11) to have stopped treatment to start a family, 53% less likely (OR = 0.47) to be satisfied (at least somewhat) with their current medication, and 42% less likely (OR = 0.58) to say they were in “good/excellent” health. Pts aged ≤ 50 years vs pts aged > 50 years were 53% less likely (OR = 0.47) to agree that reducing the need for prescription medications was important to UC management and 47% less likely (OR = 0.53) to have visited an inflammatory bowel disease center or clinic. All results shown were significant (p < 0.05). Conclusion: Substantial differences in pt-reported assessments of disease management and healthcare experience were identified, based on factors such as sex, psychological comorbidities, income, educational level, employment status, and age.Figure 1.: Most common factors impacted by psychological comorbidities. OR and relative differences (defined as OR minus 1) in pt response between pts with a) depression or b) anxiety were compared with pts without depression or anxiety, respectively. Pts with these psychological comorbidities were almost twice as likely to agree with the specified survey responses related to factors important to their quality of life and management of their UC. [a] Among pts who were employed. *p < 0.05; **p < 0.01. CI, confidence interval; OR, odds ratio; pt, patient; UC, ulcerative colitis. Table 1. - Disparities related to sex: findings in males vs females Survey response Odds ratio (95% CI) Relative differencea Say reducing fatigue is important to managing their UC 0.39 (0.29, 0.54)** 61% less likely Say being able to manage the psychological impacts of the disease is important to managing their UC 0.47 (0.34, 0.66)** 53% less likely Say avoiding toileting accidents or the need to prepare for toileting accidents is important to managing their UC 0.48 (0.35, 0.66)** 52% less likely Say being able to control pain (e.g., abdominal, joint, etc.) is important to managing their UC 0.59 (0.43, 0.80)** 41% less likely Say having less impact on familial or social relationships is important to managing their UC 0.69 (0.50, 0.96)* 31% less likely Have answered 5 of the 7 knowledge of UC questionsb correctly 0.55 (0.39, 0.77)** 45% less likely Visited an office with an IBD center/clinic in the past 12 months 0.60 (0.42, 0.84)** 40% less likely Were currently seeing their gastroenterologistc 0.66 (0.44, 0.98)* 34% less likely Have been hospitalized in the past 12 months 1.74 (1.26, 2.43)** 74% more likely Had two or more flaresd in the past 12 months 1.73 (1.23, 2.42)** 73% more likely Agree they feel comforTable discussing their health issues in their workplace (among employed patients) 1.56 (1.09, 2.22)* 56% more likely aDefined as OR minus 1bTrue or false questions relating to UC disease and treatment knowledgecQuestion: Which healthcare professionals, if any, do you currently see to manage your UC? When thinking about managing your UC, please include all healthcare professionals involved in helping you live with and treat the symptoms of your UC, such as managing your medication, treating the inflammation of your colon, etc. Please select all that applydA period where the patient experienced a dramatic increase in symptoms different from what is typically experienced*p < 0.05; **p < 0.01IBD, inflammatory bowel disease; CI, confidence interval; OR, odds ratio; UC, ulcerative colitis

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