Investigation of the Association of Acute Pancreatitis Outcomes with Social Vulnerability Indicators

Abstract

BACKGROUND AND AIM: Geospatial analyses integrate location-based sociodemographic data, offering a promising approach to investigate the impact of social determinants on acute pancreatitis (AP) outcomes. This study aimed to examine the association of social vulnerability index (SVI) and its constituent 16 attributes in 4 domains: 1) socioeconomic status, 2) household composition and disability, 3) minority status and language, and 4) housing type and transportation, with outcomes of patients with AP. METHODS: This study included AP patients hospitalized between 1/1/2008 and 12/31/2018 and recorded their demographics and clinical outcomes. Physical addresses were geocoded to determine SVI, a composite variable beyond unidimensional demographics, and the SVI were ranked and divided into quartiles (I to IV: IV representing the highest vulnerability). RESULT: In 824 patients [age of 53.0(10) years and 48.2% females], with 993 AP-related hospitalizations, we noted significantly higher prevalence of no/federal/state insurance (P<0.001) and racial minorities (P<0.001) in patients residing in communities with higher SVI. We noted a non-significant trend of higher 30-day admission rate amongst patients from higher SVI regions (III/IV: 27(18.0%)/31(18.9%) vs. I/II: 40(13.8%)/36(16.3%); p=0.49). Significantly higher odds of alcohol withdrawal were observed among patients with AP residing in areas with higher SVI ranks despite adjustment for age, body mass index, and comorbidity burden (OR:1.62[95%CI:1.19-2.22]; p= 0.003). However, we observed no association of SVI ranks with severity of AP (Revised Atlanta Classification), inpatient opioid use, time to feeding, length of stay, and mortality. CONCLUSION: We noted significantly higher alcohol withdrawal in patients residing in areas with higher SVI ranks although AP severity and other outcomes lacked significant association with SVI. Given our findings further investigation of various social determinants of health in AP is warranted in large-sized prospective studies. KEYWORDS: Alcohol Withdrawal, Geospatial Disparity