S1942 Sociodemographic Disparities in Treatment and Surgical Outcomes Among Hospitalized IBD Patients in a Large Urban Health System

Introduction: Inflammatory bowel disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), incidence rates have increased significantly among historically underrepresented populations. From 1970 to 2010, the incidence rate rose by 134% among minorities compared to a 39% increase in White populations. Despite this trend, minoritized groups remain underrepresented in IBD studies. Inpatient disparities in treatment and surgical outcomes remain underexplored. This study aimed to assess disparities in advanced therapy use, intravenous (IV) steroid exposure, and surgical interventions among hospitalized IBD patients within a large, socio-demographically diverse urban health system. Methods: We conducted a retrospective chart review of adult patients (≥18 years) hospitalized with IBD between 2019 and 2024 across 5 MedStar Health hospitals in Baltimore. Data collected included race, ethnicity, sex, Area Deprivation Index (ADI), IBD subtype, use of advanced therapy, IV steroids, and surgical intervention. Chi-square tests and multivariable logistic regression were used to evaluate associations between sociodemographic factors and outcomes. Results: Among 2,483 patients, 64% had CD, 61% were women, and 31% were Black, the highest proportion among minoritized groups. Sixty-six percent of patients were non-Hispanic White. Advanced therapy was only used in 33% of patients and was more common in CD than UC (38% vs 22%, P < 0.001), with no significant differences by race, sex, or ADI. IV steroid use was high overall (81%) and significantly higher among Black patients in unadjusted analysis (OR 1.30, 95% CI: 1.02-1.66); this association attenuated after adjustment (aOR 1.19, 95% CI: 0.92-1.57). Patients from the most socioeconomically deprived neighborhoods (5th ADI quintile) had higher odds of IV steroid use (aOR 1.56, 95% CI: 1.08-2.29). Surgical intervention occurred in 5.6% of patients, with increased odds among Hispanic patients (aOR 17.4, 95% CI: 4.00-71.43). Multiple IV steroid courses independently predicted surgery (aOR 1.67, 95% CI: 1.14-2.44). Conclusion: Disparities persist in inpatient IBD care. Higher steroid use and greater surgical risk have been noted amongst socio-demographically disadvantaged patients, reflecting potentially delayed care or advanced disease at diagnosis. Targeted interventions are necessary to promote early diagnosis and treatment, ultimately leading to more equitable outcomes.