Social Vulnerability Impacts Hospital Readmission and Alcohol Withdrawal in Acute Pancreatitis: Results of Geospatial Analysis

Introduction: Prior studies have examined the impact of certain social determinants of health on acute pancreatitis (AP) outcomes, but have not assessed the influence of the local environment. Geospatial analysis integrates location-based data with clinical information to help identify vulnerable communities. In this study, we examined the association of social vulnerability index (SVI; US Centers for Disease Control and Prevention measure of vulnerability to disasters or pandemics) with AP outcomes. Methods: We geocoded AP inpatients from 1/1/2008 to 12/31/2018 at a large tertiary center (Figure 1A). We calculated overall SVI from its 4 subcomponents (1) socioeconomic status, 2) household composition & disability, 3) minority status & language, & 4) housing type & transportation) using 15 social attributes (Figure 1B). SVIs were classified into quartiles: [I=0-0.25(least vulnerable) & IV= 0.75-1.00 (most vulnerable)]. The demographics, clinical features, hospital course, and outcomes of AP patients in the SVI quartiles were delineated and compared. The categorical variables were expressed as ratios and underwent Chi-square test. Continuous variables were expressed as median and interquartile range and underwent Kruskal Wallis test. Results: AP patients (n=839) from SVI quartiles I: 278, II: 231, III: 153, & IV: 177 had similar age & sex distribution, active smoking, alcohol use, and AP etiology. Higher SVI had increased federal/state insurance (P<0.001) and more racial minorities (P<0.001) (Figure 1C). The comparison of SVI quartiles showed no difference in BISAP score, total Morphine Milligram Equivalent requirements and time to feeding (Figure 1C; Table 1). AP patients from SVI quartiles had similar local complications, respiratory failure, acute kidney injury, and ICU stay. However, the most socially vulnerable patients had significantly higher rates of alcohol withdrawal (P=0.03). Although mortality, length of stay, and rehabilitative requirements were similar, SVI IV had significantly higher number of readmissions in 1 year compared to SVI I (P=0.04). Conclusion: SVI is a promising composite variable to study AP outcomes beyond unidimensional patient characteristics. We noted significantly higher readmissions and alcohol withdrawal in AP patients with higher social vulnerability. Strong consideration should be given to factors contributing to higher SVI to optimize discharge planning and follow-up.Figure 1.: (A) Geocoded Acute Pancreatitis patients cared for at a large tertiary center (B) Social Vulnerability Index based on subcomponents and social attributes (C) Acute Pancreatitis patient demographics, clinical course, and outcomes. Table 1. - Description of Demographics, Clinical Course, and Outcomes of AP Patients From Various Social Vulnerability Index Quartiles Paramaters Ist Quartile:n=278 (SVI 0-0.25) IInd Quartile: n=231 (SVI 0.26-0.50) IIIrd quartile: n=153 (SVI 0.51-0.75) IVth quartile: n=177 (SVI 0.76-1.0) P value Female sex (n) 132 123 78 78 0.12 Race: ethnicity: White/Black/Hispanic/Asian/Other 241/20/2/9/2 195/24/0/7/3 101/39/1/6/1 72/90/1/5/1 < 0.001 Age (median (IQR in years) 58.9(21.8) 44(25.6) 61.1(26.1) 50.9(25.2) 0.10 Smoking status (n) 111 102 65 89 0.23 Alcohol Exposure (n) 151 128 72 100 0.23 Etiology: Gallstone/Alcohol/PEP/HyperTG/ 69/48/7/2/ 70/41/5/4/ 46/38/5/0/ 38/43/4/0/ 0.20 Mass/other/idiopathic 40/18/94 34/5/66 20/6/43 40/8/48 Insurance type: Private/federal/no insurance 124/131/23 82/130/19 47/95/11 37/125/15 < 0.001 CCI score (median (IQR)) 3(3) 1.33(2) 2(5) 2(3) 0.86 BISAP (median (IQR)) 1(1) 0(1) 1(1) 0(1) 0.13 Length of stay (median (IQR)) 5.0(6.0) 4.0(3.8) 5.0(6.0) 4.0(2.9) 0.58 Total MME during hospitalization (median (IQR)) 14.0(80) 15.15(61.0) 11(18.0) 16(37.0) 0.70 Visual Analog scale at Presentation/Discharge (median (IQR)) 7.5(6)/0(1) 7(4)/ 4.5(2) 7(5)/ 0(2) 8(4)/ 0(3) 0.11/0.49 Days to Nutritional advancement (median (IQR)) 2(2) 2(2) 1(2) 2(2) 0.46 Local complications: pancreatic necrosis, walled-off collections, pseudocysts, and splanchnic thrombosis (n) 162 117 77 86 0.40 Respiratory failure requiring mechanical ventilation (n (%)) 5 3 2 5 0.70 Acute Kidney Injury 2 1 3 2 0.48 Alcohol withdrawal (n) 5 9 9 13 0.03 Number of re-admissions within 1 year (median (IQR)) 1(3) # 1(2) 1(2) 2(4) # 0.04 Discharge to rehabilitation centers (n) 5 13 4 5 0.15 Mortality within 1 year (n) 2 1 4 1 0.13