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Social deprivation does not impact on acute pancreatitis severity and mortality: a single-centre study
Wei Boon Lim1, Francis P Robertson1, Manu K Nayar1
1Department of HPB and Transplant Surgery, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
Insights
Social deprivation is linked to more acute pancreatitis (AP) admissions, but does not predict mortality. Early identification of high-risk patients with AP remains a challenge, despite increased resource needs for severe cases.
Area of Science:
- Gastroenterology
- Public Health
- Surgical Outcomes
Background:
- Acute pancreatitis (AP) incidence is rising in the UK, placing a strain on healthcare resources.
- Predicting severe AP and multiorgan dysfunction is challenging, delaying critical interventions.
- Social deprivation is associated with poorer outcomes in surgery, but its impact on AP mortality is unclear.
Purpose of the Study:
- To investigate the association between social deprivation and mortality in patients with acute pancreatitis.
- To determine if social deprivation can be used as a predictor for identifying high-risk AP patients for early intervention.
Main Methods:
- Analysis of a prospectively collected single-centre database of 398 AP patients (2018-2021).
- Calculation of English Index of Multiple Deprivation (IMD) based on postcode.
- Grouping patients by IMD quintiles to compare outcomes: mortality, ITU admission, length of stay, and complications.
Main Results:
- Significantly more AP patients originated from the most deprived quintiles (Q1) compared to the least deprived (Q5).
- Patients from deprived areas were younger, more likely to be smokers, and had higher rates of ischemic heart disease (IHD).
- No significant difference in AP-related complications, ITU admissions, organ support, or length of stay was found across IMD quintiles.
Conclusions:
- While socially deprived populations have a higher incidence of AP, social deprivation itself does not correlate with mortality post-AP.
- Current methods for predicting severe AP and identifying high-risk patients need improvement.
Background And Aims:
The incidence of acute pancreatitis (AP) is increasing in the UK. Patients with severe AP require a significant amount of resources to support them during their admission. The ability to predict which patients will develop multiorgan dysfunction remains poor leading to a delay in the identification of these patients and a window of opportunity for early intervention is missed. Social deprivation has been linked with increased mortality across surgical specialties. Its role in predicting mortality in patients with AP remains unclear but would allow high-risk patients to be identified early and to focus resources on high-risk populations.
Methods:
A prospectively collected single-centre database was analysed. English Index of Multiple Deprivation (IMD) was calculated based on postcode. Patients were grouped according to their English IMD quintile. Outcomes measured included all-cause mortality, Intestive care unit (ITU) admission, overall length of stay (LOS) and local pancreatitis-specific complications.
Results:
398 patients with AP between 2018 and 2021 were identified. There were significantly more patients with AP in Q1 (IMD 1-2) compared with Q5 (IMD 9-10) (156 vs 38, p<0.001). Patients who were resident in the most deprived areas were significantly younger (52.4 in Q1 vs 65.2 in Q5, p<0.001), and more often smokers (39.1% in Q1 vs 23.7% in Q5, p=0.044) with IHD (95.0% vs 92.1% in Q5, p<0.001). In multivariate modelling, there was no significance difference in pancreatitis-related complications, number of ITU visits, number of organs supported and overall, LOS by IMD quintile.
Conclusions:
Although there was a significantly higher number of patients admitted to our unit with AP from the most socially deprived quintiles, there was no correlation between social economic deprivation and mortality following AP.
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