Do providers fail to recognize anxiety in socially vulnerable patients with inflammatory bowel disease?

Abstract INTRODUCTION Social determinants of health (SDOH) are increasingly recognized for their role in perpetuating an inequitable healthcare system, particularly for those with chronic disease. Patients with inflammatory bowel disease (IBD) are likely subject to many of the same inequities, but data on SDOH and IBD outcomes are lacking. The social vulnerability index (SVI) is a publicly available tool from the Centers for Disease Control that provides neighborhood-level estimates of social need with higher values on a 0-1 scale indicating greater social vulnerability. The SVI has been used in other chronic diseases to determine which patients are at risk for poor outcomes, such as anxiety and depression. Utilizing census tract-level SVI data, we aimed to identify the relationship between SDOH and diagnoses of anxiety and depression in patients with IBD. METHODS We used a retrospective cohort of patients at a single IBD center between 01/01/2015 and 08/31/2022. Using the current address in the electronic medical record, we geocoded patients to individual census tracts and linked them to corresponding SVI and subscales (Figure 1). Controlling a priori for age, gender, race, ethnicity, marital status, English proficiency, religious affiliation, and tobacco use, we used multivariable logistic regression to examine the relationship between SVI and the diagnoses of depression and anxiety in patients with IBD. RESULTS Depression was increased but not significantly associated with higher total social vulnerability (OR 1.12, 95% CI 0.93-1.34, p=0.2). Depression was associated with higher scores on Socioeconomic Status (SES) (OR 1.36, 95% CI 1.05-1.76, p= 0.020) and Minority Status/Language (OR 1.22, 95% CI 1.03-1.44, p= 0.018). In contrast, anxiety was significantly associated with lower levels of social vulnerability (OR 0.77, 95% CI 0.64-0.92, p= 0.005) but associated with higher scores on Minority Status/Language (OR 1.36, 95% CI 1.16-1.60, p<0.001). The remainder of SVI sub-scores either had no relationship with anxiety and depression or had a negative association with the outcome (Table 1). CONCLUSIONS Depression and anxiety were associated with living in socioeconomically disadvantaged and racially diverse neighborhoods; however, patients with higher total SVI and higher scores on the Household Composition were unexpectedly found to have reduced odds of developing anxiety. While these findings were initially surprising, we found them to be in line with current literature that suggests racial/ethnic minorities and low SES individuals are less likely to receive mental health diagnoses, yet suffer from these conditions at similar rates as their white and more affluent counterparts. Future research is needed to improve the mental health dialogue between providers and minority patients and ensure that minority and low SES patients are receiving equitable care.