DEPRESSION AND RACIAL DISPARITIES IN CROHN’S FLARE HOSPITALIZATIONS: A NATIONAL ANALYSIS, 2020-2021

Abstract INTRODUCTION Crohn’s disease (CD) often requires hospitalization for flares, driving morbidity and cost. Depression affects ∼25% of inflammatory bowel disease (IBD) patients and is coded in 17% of U.S. IBD admissions, above general population rates. Depression increases hospitalization, length of stay (LOS), cost, and acute interventions, and prevalence rose further during COVID-19. Despite screening recommendations, little is known about how depression affects outcomes in CD flare admissions or whether racial disparities contribute to excess burden. METHODS We performed a retrospective cohort study of 2020–2021 National Inpatient Sample (NIS) adult CD flare admissions. Depression was defined by secondary ICD-10-CM codes; outcomes were LOS, hospitalization cost, and in-hospital mortality. Weighted multivariable regression adjusted for demographic, hospital, and clinical covariates, with race-stratified analyses among White, Black, Hispanic, and Asian patients (p < 0.05). RESULTS Among 24,506 weighted CD flare admissions, 14.2% carried coded depression. Compared with non-depressed patients, those with depression had longer stays (mean 5.5 vs. 5.0 days; adj β + 0.65, p < 0.001) and higher charges (mean $55,714 vs. $53,446; adj +10.8%, p < 0.001). Mortality was low and did not increase with depression (0.32% vs. 1.07%; adj risk diff –0.76 pts, p < 0.001). In race-stratified analyses among depressed patients, significant disparities were observed. Black (5.8 days), Hispanic (6.4), and Asian/Pacific Islander (6.1) patients had longer LOS compared with White patients (5.3, p < 0.05 for all). Hospital charges were higher for Hispanic ($63,512, p < 0.05) and Asian/Pacific Islander patients ($107,369, p < 0.001) relative to White patients ($54,121), with Black patients showing modest but nonsignificant elevation ($55,863, p = 0.07). Mortality remained low and did not differ significantly by race. DISCUSSION In this national analysis of CD flare admissions, depression was independently associated with longer hospitalizations and higher cost, without increased mortality. These findings support depression as a modifiable driver of healthcare utilization in IBD. Importantly, we demonstrate that racial disparities further compound this burden: Black, Hispanic, and Asian patients with depression experienced significantly longer stays, while Hispanic and Asian patients incurred substantially higher costs compared with Whites. These inequities likely reflect systemic differences in screening, diagnosis, and treatment access rather than intrinsic disease variation. By isolating flare-related admissions and incorporating race-stratified analyses, this study advances beyond prior IBD-wide reports and identifies depression as a critical, modifiable contributor to inequity in CD care.