EPD307 - The Impact of Geographic Food Disparities on Patients with Inflammatory Bowel Disease

Purpose/Background: Inflammatory bowel disease (IBD) requires a multipronged approach for management. Diet is often overlooked but is increasingly recognized as a crucial component of maintaining patients' overall health. While no specific diet is universally recommended, diets high in ultra-processed foods have been strongly associated with the development of IBD and an increased risk of disease flares. Geography, which acts as a surrogate for socioeconomic status, can have a tremendous impact on the food options available to patients with IBD. Therefore, we aimed to evaluate the relationship between food environment and outcomes in patients with IBD.

Methods/Interventions: We examined the relationship between neighborhood-level characteristics in the state of Connecticut and hospitalizations of patients with IBD utilizing an institutional database. Included patients were 18 years and older, had a diagnosis of IBD as defined as Crohn's of any location and/or complication or Ulcerative Colitis, and were seen by any IBD-specific medical or surgical provider within one academic tertiary referral center from 8/2023 to 8/2025. Census-level data and the CDC's modified Retail Food Environment Index (mRFEI) were used to establish an Unhealthy Food Environment Index ("UFEI"), defined as the proportion of unhealthy retailers to the total number of retailers within a half-mile boundary of each census tract (range 0-100; higher numbers represent an unhealthier environment). Residential addresses were geocoded to US census tracts and scored accordingly. Clinical features were summarized as frequency (percentage) or median (interquartile range [IQR]). Poisson regression models were used to investigate the relationship between the UFEI and patient outcomes.

Results/Outcomes: In total, 2,505 patients with IBD were included (Table 1). The median age was 50 years (IQR, 36-64 years) and 52% (1,305/2,505) of the population were female. Fourteen percent (340/2,505) of patients visited the emergency department within the last 90 days at the time of data abstraction, and 7.1% (179/2,505) required hospitalization. The median UFEI was 84 (IQR 50-100). When patients were divided into tertiles based on UFEI, patients in the highest UFEI group had the greatest proportion of ED visits and hospitalizations (Figure 1). After adjusting for age, a higher UFEI was significantly associated with an increased risk of emergency department visits (X2=7.23, p=0.027). Furthermore, the risk of hospitalization amongst IBD patients was significantly associated with a higher UFEI when adjusting for age (X2=20.3, p< 0.001).

Conclusion/Discussion: For patients with IBD, living in an unhealthy food environment is associated with an increased risk of both emergency department visits and hospitalizations. Utilizing geocoding, health systems can identify the patients with IBD who are most at risk for poor outcomes, and implement targeted interventions for these patients to improve overall health.

Table 1. Demographics and Clinical Characteristics of All Patients (N=2505)
Figure 1. ED Visits and Hospitalizations in Patients with IBD by UFEI