The influence of socioeconomic inequity and guidelines compliance on clinical outcomes of patients with acute biliary pancreatitis. An international multicentric cohort study

INTRODUCTION This study examined the interplay between socio-economic factors, guideline adherence, and clinical outcomes among patients with acute biliary pancreatitis (ABP). METHODS A post-hoc analysis of the international MANCTRA-1 study was conducted to evaluate the impact of regional disparities, socioeconomic status of countries as indicated by the Human Development Index (HDI), and guideline compliance on ABP mortality and readmission. Multivariable logistic regression models were employed to identify prognostic factors associated with mortality and readmission. RESULTS Among 5313 individuals from 151 centres across 42 countries in Europe, Asia, Africa, the Americas, and Australia, marked disparities in comorbid conditions, ABP severity, and medical procedure usage were observed among different regions (p<0.001). Patients from lower HDI countries had higher guideline non-compliance (p<0.001) and mortality (5.0% vs. 3.2%, p=0.019) in comparison with very high HDI countries. On adjusted analysis, ASA score (OR 1.810, p=0.037), severe ABP (OR 2.735, p<0.001), infected necrosis (OR 2.225, p=0.006), organ failure (OR 4.511, p=0.001) and guideline non-compliance (OR 2.554, p=0.002 and OR 2.178, p=0.015) were associated with increased mortality. Of note, HDI was a critical socio-economic factor affecting both mortality (OR 2.452, p=0.007) and readmission (OR 1.542, p=0.046). CONCLUSION These data highlight the importance of collaborative research to characterise challenges and disparities in global ABP management. Less developed regions with lower HDI scores showed lower adherence to clinical guidelines and higher rates of mortality and recurrence. Prioritising and promoting global awareness of evidence-based medicine for common benign diseases is imperative.