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Investigating Intestinal Inflammation in DSS-induced Model of IBD
Published on: February 1, 2012
Inflammatory bowel disease outcomes among hospitalized homeless individuals
Tushar Mungle1, Vivek Charu2,3, Philip N Okafor4
1Department of Medicine, Stanford University, Stanford, CA, USA.
Insights
Homeless individuals with inflammatory bowel diseases (IBD) experience similar inpatient outcomes to those with stable housing. This study found comparable mortality and endoscopy rates, with some variations in surgical complications for Crohn's disease and ulcerative colitis patients.
Area of Science:
- Gastroenterology
- Public Health
- Health Services Research
Background:
- Limited data exists on healthcare outcomes for homeless individuals diagnosed with inflammatory bowel diseases (IBD).
- This study addresses the critical need for outcome data in this vulnerable patient population.
Purpose of the Study:
- To determine and compare inpatient outcomes between homeless and non-homeless individuals diagnosed with Crohn's disease (CD) and ulcerative colitis (UC).
- To analyze rates of mortality, endoscopy utilization, surgical treatment, and post-operative complications.
Main Methods:
- Utilized the Healthcare Utilization Project (HCUP) State Inpatient Databases (2013-2014) for four US states.
- Employed propensity score matching to compare outcomes between homeless (n=884) and non-homeless (n=109,124) IBD patients.
- Analyzed differences in mortality, endoscopy, surgery, and complications using odds ratios and 95% confidence intervals.
Main Results:
- Homelessness represented 0.7% of Crohn's disease (CD) and 0.9% of ulcerative colitis (UC) hospitalizations.
- Mortality and endoscopy utilization were similar between homeless and non-homeless IBD patients.
- Surgical treatment showed lower odds of bowel resection in homeless UC patients. Post-operative complications varied, with lower venous thromboembolism rates in homeless CD patients but higher rates in homeless UC patients.
Conclusions:
- Homeless patients with IBD demonstrate comparable inpatient outcomes to their housed counterparts.
- Findings suggest that existing healthcare systems may be effectively managing IBD in homeless populations during inpatient stays.
- Further research into outpatient and long-term management strategies for homeless IBD patients is warranted.
Background:
There is a paucity of outcome data among homeless individuals with inflammatory bowel diseases (IBD). We reported rates of homelessness among inpatients with Crohn's disease (CD) and ulcerative colitis (UC) and examined inpatient outcomes.
Methods:
The Healthcare Utilization Project (HCUP) State Inpatient Databases from New York, Arizona, Massachusetts and Florida for 2013 and 2014 were used to identify adults ≥ 18 years admitted with IBD identified by ICD-9 codes. Homeless patients were propensity score matched using a one-to-ten greedy nearest-neighbor approach to non-homeless patients to balance the distribution of baseline covariates. Differences in mortality, endoscopy utilization, surgical treatment and post-operative complications were reported as odds ratios with 95% confidence intervals (CI).
Results:
A total of 115,008 IBD hospitalizations were identified of which 61% (n = 70,457) were CD discharges while 39% (n = 44,551) were UC discharges. Homelessness was associated with 0.7% (n = 469) of CD discharges and 0.9% (n = 415) of UC discharges. Mortality and endoscopy utilization rates were comparable between homeless and non-homeless patients with CD and UC. Surgical treatment was also broadly similar except for lower odds of bowel resection among homeless IBD patients with UC compared to domiciled IBD patients with UC (OR: 0.41, 95% CI: 0.20 to 0.84). Post-operative complications were also comparable except for lower rates of venous thromboembolism among homeless patients with CD (OR: 0.61, 95% CI: 0.38 to 0.97) whereas it was higher for homeless patients with UC (OR: 1.58, 95% CI: 1.08 to 2.30).
Conclusions:
Homeless IBD patients have comparable inpatient outcomes with non-homeless IBD patients.
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