S2039 Acute Severe Ulcerative Colitis: Uncovering the Gender Gap

Introduction: Acute Severe Ulcerative colitis (ASUC) is a dreaded complication of Ulcerative colitis (UC). Management consists of intravenous corticosteroid administration along with either biologic agents or cyclosporine. Colectomy is reserved for refractory cases. Nationwide data on the presence of a gender gap in treatment outcomes of ASUC remain limited. This study aims to answer this important question using the largest national readmission database. Methods: This is a retrospective cohort study using the National Readmission Database 2018-2022. The Patients were included if they were admitted during the month of January with a principle diagnosis of ASUC. The exposure was patient’s sex. The follow-up period was 12 months. The primary outcome was the rate of colectomy. The secondary outcomes were all-cause mortality, resource utilization and independent predictors of colectomy. Confounders were adjusted for using regression analysis models and were age, income in the patient’s zipcode, insurance type, Charlson score and hospital bedsize, teaching status and urban location. Charges and costs were adjusted for inflation using the consumer price index. Diagnoses were identified using appropriate International Classification of Diseases-10 CM codes. Results: 4,494 patients were included in the study, 51% of whom were females. Compared with males, female patients were slightly older (45 vs 42 years, P = 0.01) and more likely to be insured by Medicare (27% vs 20%, P = 0.03). After adjusting for confounders, female patients had lower adjusted odds of colectomy (aOR: 0.69 (0.53-0.92), P = 0.01) over 12 months, but similar adjusted odds of 1 year mortality (aOR: 0.97 (0.48-1.94), P = 0.97) as well as adjusted mean total hospitalization charges ($5,103 (-$9,162-$19,369 ), P = 0.48 and costs ($235 (-$2,304-$2,776), P = 0.86). Several factors were tested to identify independent predictor of colectomy including age, income, insurance, charlson score, hospital bedsize, urban location and teaching status. Only gender was found to affect the odds of colectomy. Conclusion: Among patients with acute severe ulcerative colitis, females are less likely to have a refractory disease requiring a colectomy, despite similar resource utilization during the index and subsequent admissions. No other factor tested was an independent predictors of refractory disease. This disparity in response to treatment does not affect long term mortality. More research is needed to uncover the reasons behind this gender gap as a first step to addressing and eliminating it.