IMPACT OF SOCIOECONOMIC DISPARITIES ON HOSPITAL OUTCOMES IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE AND CANCER

Abstract BACKGROUND Socioeconomic inequities are increasingly acknowledged as key drivers of worse outcomes in inflammatory bowel disease (IBD). Individuals with both IBD and concomitant malignancy represent a highly vulnerable population, However, the impact of race, income, and insurance status on hospitalization outcomes in this population remains underexplored. METHODS We analyzed the 2020–2022 National Inpatient Sample to examine adult hospitalizations with IBD and concurrent malignancy. Survey-weighted multivariable models adjusted for demographics, comorbidity, admission features, and hospital factors were applied to assess the independent association of race/ethnicity, income quartile, and primary payer with in-hospital mortality, discharge disposition, length of stay (LOS), and hospitalization cost. Mortality and discharge were analyzed using logistic regression, negative binomial regression was used for LOS and generalized linear models with a gamma distribution for cost. RESULTS In total, 14,269 hospitalizations were identified, reflecting 71,345 weighted cases. In-hospital mortality was 3.2%, mean LOS was 7.8 days, and mean cost was $63,500. After adjustment, Black patients had significantly higher odds of mortality compared with White patients (aOR 1.38, 95% CI 1.07–1.77). However, differences in LOS and cost were not detected. Patients from the lowest income quartile were subject to longer hospitalizations (IRR 1.07, 95% CI 1.01–1.14) compared to the highest quartile. Medicare beneficiaries had greater odds of discharge to a facility (aOR 1.35, 95% CI 1.22–1.49) and longer LOS (IRR 1.06, 95% CI 1.00–1.12). No significant outcome differences were observed among Hispanic or Asian/PI patients and White patients. CONCLUSIONS Between hospitalized patients with IBD and malignancy, socioeconomic disparities remain despite adjustment for comorbidity and hospital factors. Black patients experienced higher in-hospital mortality, lower-income patients had longer hospitalizations, and Medicare beneficiaries were more likely to need post-acute care. Our results underscore the need for targeted strategies aimed at reducing structural inequities to enhance outcomes for high-risk IBD populations