S902 Effect of Social Determinants of Health on Healthcare Costs and Access to Care in Patients With Eosinophilic Esophagitis: A Retrospective Cohort Study of U.S. Health Insurance Claims Data

Introduction: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by symptoms of esophageal dysfunction. Social determinants of health (SDoH) may affect clinical outcomes. Methods: This retrospective, longitudinal cohort study (January 1, 2016-December 31, 2022) examined U.S. health insurance claims and enrollment data for patients with EoE from the Inovalon closed claims (ICC) database and the 100% sample of Medicare Fee-For-Service (MFFS) parts A/B/D. Eligible patients had ≥2 claims (≥30 days apart) with a diagnosis code for EoE (International Classification of Diseases (ICD)-10-CM: K20.0) in the index period (January 1, 2017-December 31, 2021 [index date = first of these claims]); had continuous enrollment in medical and pharmacy benefits for ≥12 months before and after the index date (baseline and follow-up periods, respectively); and were aged ≥11 years at index. Patients were excluded if they had a claim for eosinophilic gastritis/gastroenteritis (ICD-10-CM: K52.81) post-index. SDoH data were linked via Zip code to patients from the Acxiom Market Indices and other sources using a HIPAA-compliant safe harbor database. The effect of SDoH factors (Area Deprivation Index [ADI], distance to a patient’s diagnosing provider and rurality at index) on EoE-related healthcare costs, time to diagnosis and likelihood of pharmacological treatment was examined during follow-up (except for time to diagnosis, which was assessed from disease onset [baseline] to diagnosis [index date]) using regression modelling. Results: Overall, 40,619 patients diagnosed with EoE were included (ICC, N = 26,340; MFFS, N = 14,279). Patient demographics (ICC and MFFS): mean (standard deviation) age at index, 38.0 (16.8) and 67.0 (13.1) years; men, 58.8% and 50.4%. For both ICC and MFFS, patients diagnosed with EoE living in urban/suburban areas were diagnosed significantly more quickly than those living in rural areas (ICC, by 36.5 days, P < 0.001; MFFS, by 32.9 days, P = 0.02. Patients living in Zip codes in the fourth to fifth (i.e., most deprived) versus the first to third quintiles for the ADI had a 6% increase in costs (P < 0.001; ICC only), had a longer time to diagnosis (by 32.9 days, P < 0.001; ICC only) and were more likely to receive treatment (ICC, by 18%, P < 0.001; MFFS, by 23%, P = 0.003. Conclusion: SDoH can affect time to diagnosis, healthcare costs, and the likelihood of treatment for patients with EoE; these results, along with the effect of sex, race and how ADI and rurality interact, require further investigation.