AIBD Poster Award Winner: Dana Neugut, MD

Dr Neugut reviews her award-winning poster from AIBD on the association of Childhood Opportunity Index with time to infliximab discontinuation in pediatric patients with inflammatory bowel disease.

Dana Neugut, MD, is a third-year pediatric GI fellow at the Children's Hospital of Philadelphia.

TRANSCRIPT

Hi, my name is Dana Neugut, and I'm a third-year pediatric GI fellow at the Children's Hospital of Philadelphia. Social determinants of health have a profound effect on health outcomes, including on inflammatory bowel disease. Childhood Opportunity Index is a measure that uses U .S. Census-derived variables to measure neighborhood-level social determinants of health and has been associated with pediatric health outcomes.

In our study, we looked at whether Childhood Opportunity Index is associated with time to infliximab discontinuation in pediatric patients with inflammatory bowel disease. We conducted a single center retrospective cohort study of pediatric patients ages 0 to 22 years who started infliximab between 2011 to 2023 for IBD. We measured Childhood Opportunity Index using their home address at the time of first infliximab dose. We also looked at time to infliximab discontinuation as defined as receiving an infusion followed by at least 14 weeks without any infusion.

We looked in their charts and extracted information on the reason of infliximab discontinuation and sorted them into two categories. One is patients who stopped infliximab for medical reasons, such as continued disease activity or development of antibodies. And the second category was people who stopped infliximab for nonmedical reasons, such as insurance problems or lost to follow-up. In total, we had 1025 patients included in the study. There was a mean age of 12 .9 years, and approximately 44 % of the patients were female. Three hundred and forty-four patients discontinued infliximab during the study period, including 251 for a medical reason and 83 for a nonmedical reason. We conducted Cox proportional hazards ratios to test whether Childhood Opportunity Index was associated with time to infliximab discontinuation. And we performed LASSO regression to figure out what to include in multivariable models.

Overall, there was no significant association between Childhood Opportunity Index and time to infliximab discontinuation in our pediatric cohort. In subgroup analyses, we looked at whether there were associations in patients who discontinued for a medical or nonmedical reason. In the medical group, there still was no significant association.

However, we did find a significant association between Childhood Opportunity Index and time to infliximab discontinuation in patients who stopped for a nonmedical reason. This was an inverse association, meaning that on the whole, patients who had lower childhood opportunity had faster time to infliximab discontinuation in this group who stopped for nonmedical reasons.

Going forward, we plan to confirm these findings and investigate the underlying reasons for this disparity. In the long term, we hope that this research can help minimize disparities in pediatric patients with IBD.

I'd like to thank doctors Brad Constant and Lindsay Albenberg for their mentorship and the entire study team for their work on this project.