S1469 Evaluating the Key Risk Factors for Crohn’s Disease Flares in a Marginalized Population

Introduction: Crohn’s disease is influenced by both genetic and environmental factors. Biochemical factors to psychological factors have been associated with a Crohn’s flare. However, specific factors and their level of influence remain unclear. This study aims to identify potential risk factors for Crohn’s flares in a marginalized population. Methods: A retrospective chart review was conducted on patients over the age of 18 admitted to a county hospital with Crohn’s flare between January 2019 and May 2024. Data collected included demographics, co-morbidities, medication history, substance use, laboratory values, endoscopic findings, social determinants of health, and inpatient management. Results are presented as the percentage of patients with each risk factor relative to the total cohort. Results: There were equal proportions of males and females in this study. Most prevalent co-morbidities included anxiety (34%) and depression (26%). Fifty-three percent of patients were on inflammatory bowel disease treatment with most being on infliximab (75%). Thirty-five percent reported non-adherence and 20% failed biologics. Seventy-one percent reported prior hospitalizations. Sixty-three percent and fifty-three percent of patients who underwent colonoscopy and esophagogastroduodenoscopy respectively had active inflammation. Average inflammatory markers were elevated in this cohort. Steroids were used for almost all inductions. Infliximab was used for maintenance in 11% of cases. Most patients did not have surgery during admission (83%). The average length of stay was 8 days. Forty-eight percent of patients were discharged on steroids, and 28% were discharged on a biologic. Conclusion: Most Crohn’s flare patients did not report increased antibiotics, substance, or non-steroidal anti-inflammatory drug use. Many presented with psychosocial stressors, but most patients did not report non-adherence as a result. Most had adequate outpatient care, but progressive disease as evidenced by re-hospitalization rate and active inflammation on admission. Even with access to care, Crohn’s can progress due to biological and psychosocial mechanisms as opposed to modifiable lifestyle factors or non-adherence. However, only 53% of patients were on treatment, indicating care gaps likely due to socioeconomic and psychosocial factors with the hospital primarily serving a marginalized population. Interestingly, only 26% reported economic factors affecting access to care which may also imply health literacy affecting access to care.