Racial Variations in Pain Management and Outcomes in Hospitalized Patients With Acute Pancreatitis

McHenry, Nicole; Shah, Ishani; Ahmed, Awais; Freedman, Steven D.; Kothari, Darshan; Sheth, Sunil G.

doi:10.1097/mpa.0000000000002160

Cited by 8 publications

(2 citation statements)

References 17 publications

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“…Patient demographics (including age, sex, race and ethnicity, active smoking or alcohol use, etiology of AP, insurance type and address), and clinico-radiologic information were extracted through review of individual EHR. 24, 25 The ethnoracial features were self-reported and verified by health care practioners. Additionally, we quantified the comorbidity burden for each participant using the Charlson Comorbidity Index (CCI).…”

Section: Methodsmentioning

confidence: 99%

Impact of Geospatial Food Access on Acute Pancreatitis Outcomes

Chhoda,

Noriega,

Kahan

et al. 2024

Preprint

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BACKGROUND AND AIM: Food access is an important social determinant of health and refers to geographical and infrastructural aspects of food availability. Using publicly available data on food access from the United States Department of Agriculture (USDA), geospatial analyses can identify regions with variable food access, which may impact acute pancreatitis (AP), an acute inflammatory condition characterized by unpredictable outcomes and substantial mortality. This study aimed to investigate the association of clinical outcomes in patients with AP with geospatial food access. METHODS: We examined AP-related hospitalizations at a tertiary center from January 2008 to December 2018. The physical addresses were geocoded through ArcGIS Pro2.7.0 (ESRI, Redlands, CA). USDA Food Access Research Atlas defined low food access as urban areas with 33% or more of the population residing over one mile from the nearest food source. Regression analyses enabled assessment of the association between AP outcomes and food access. RESULTS: The study included 772 unique patients with AP residing in Massachusetts with 931 AP-related hospitalizations. One hundred and ninety-eight (25.6%) patients resided in census tracts with normal urban food access and 574 (74.4%) patients resided in tracts with low food access. AP severity per revised Atlanta classification [OR: 1.88 (95%CI: 1.21-2.92); p=0.005], and 30-day AP-related readmission [OR: 1.78(95%CI: 1.11-2.86); p=0.02] had significant association with food access, despite adjustment for demographics, healthcare behaviors, and comorbidities (Charlson Comorbidity Index). However, food access lacked significant association with AP-related mortality (p=0.40) and length of stay (LOS: p=0.99). CONCLUSION: Low food access had a significant association with 30-day AP-related readmissions and AP severity. However, mortality and LOS lacked significant association with food access. The association between nutrition, lifestyle, and AP outcomes warrants further prospective investigation.

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Section: Methodsmentioning

confidence: 99%

Impact of Geospatial Food Access on Acute Pancreatitis Outcomes

Chhoda,

Noriega,

Kahan

et al. 2024

Preprint

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“…We reviewed the EHR to collect a wide range of data, including demographic, clinical, laboratory, radiological and treatment information for patients with AP. 16, 17 The demographic characteristics considered for each patient included age, sex, race and ethnicity, active smoking or alcohol use, etiology of AP, insurance type and address. To accurately locate each patient, we identified and geocoded their local street address.…”

Section: Methodsmentioning

confidence: 99%

Investigation of the Association of Acute Pancreatitis Outcomes with Social Vulnerability Indicators

Chhoda,

Liyen-Cartelle,

Noriega

et al. 2024

Preprint

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BACKGROUND AND AIMGeospatial analyses integrate location-based sociodemographic data, offering a promising approach to investigate the impact of social determinants on acute pancreatitis (AP) outcomes. This study aimed to examine the association of social vulnerability index (SVI) and its constituent 16 attributes in 4 domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation), with outcomes of patients with AP.METHODSThis study included AP patients hospitalized between 1/1/2008 and 12/31/2018 and recorded their demographics and clinical outcomes. Physical addresses were geocoded to determine SVI, a composite variable which was ranked and divided into quartiles (I to IV: IV representing the highest vulnerability).RESULTIn 824 patients [age of 53.0±10 years and 48.2% females], with 993 AP-related hospitalizations, we noted significantly higher prevalence of no/federal/state insurance(P<0.001)and racial minorities(P<0.001)in patients residing in communities with higher SVI. A non-significant trend of higher 30-day admission rate amongst patients from higher SVI regions (III/IV: 27(18.0%)/31(18.9%)vs.I/II: 40(13.8%)/36(16.3%);p=0.49) was noted. We observed a significant association of alcohol withdrawal with residence in areas with higher SVI despite adjustment for age, body mass index, and comorbidities (OR:1.62[95%CI:1.19-2.22];p=0.003). However, we observed no association of SVI with severity of AP, inpatient opioid use, length of stay, and mortality.CONCLUSIONWe noted significantly higher alcohol withdrawal in patients residing in areas with higher SVI ranks although AP severity and other outcomes lacked significant association with SVI. Given our findings further investigation of various social determinants of health in AP is warranted in large sized prospective studies.

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Global trends in opioid use for pain management in acute pancreatitis: A multicentre prospective observational study

Knoph,

Lucocq,

Kamarajah

et al. 2024

UEG Journal

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BackgroundSince there is no current international consensus on the optimal approach for pain management in acute pancreatitis (AP), analgesic practices may vary across different healthcare settings.ObjectiveThis study explored global disparities in analgesic use, in particular opioids, during admission and at discharge in hospitalised AP patients.MethodsThis was a post hoc analysis of the prospective PAINAP database, which included all admissions for AP between April and June 2022 with a 1‐month follow‐up. Demographic details, analgesic use, and clinical outcomes were recorded during admission and at discharge. Odds ratios (ORs) for opioid use during admission and at discharge were identified using multivariable regression analyses.ResultsAmongst the 1864 patients (52% males, median age 56 (interquartile range, 41–71)) across three different continents, simple analgesics were predominantly used as the primary analgesic (70%). Opioid use during admission was lowest in European centres (67%). Admission in Asian (OR, 2.53 (95% confidence interval (CI), 1.59–4.04), p < 0.001), and Australian (OR, 5.81 (95% CI, 3.19–10.56), p < 0.001) centres was associated with opioid administration during admission compared with European centres. Increased pain severity, longer pre‐admission pain duration, organ failure, and longer length of admission increased opioid use during admission. At discharge, Asian (OR, 2.01 (95% CI, 1.40–2.88), p < 0.001) and Australian (OR, 1.91 (95% CI, 1.28–2.85), p = 0.002) centres were associated with opioid prescription compared with European centres. Increased pain severity, longer pre‐admission pain duration, acute necrotic collections, and walled‐off necrosis also increased the likelihood of opioid prescription at discharge.ConclusionThere are substantial intercontinental differences in opioid use for AP pain. Accordingly, there is a need for international guidelines on pain management in AP.

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Racial Variations in Pain Management and Outcomes in Hospitalized Patients With Acute Pancreatitis

Cited by 8 publications

References 17 publications

Impact of Geospatial Food Access on Acute Pancreatitis Outcomes

Impact of Geospatial Food Access on Acute Pancreatitis Outcomes

Investigation of the Association of Acute Pancreatitis Outcomes with Social Vulnerability Indicators

Global trends in opioid use for pain management in acute pancreatitis: A multicentre prospective observational study

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