Health Disadvantage Contributes to Crohn Disease Symptom Continuation During Remission

Unfavorable neighborhood conditions can contribute to the persistence of GI symptoms in patients with Crohn disease in endoscopic remission.

The health disadvantage of unfavorable neighborhood living conditions increases the risk for persistent gastrointestinal (GI) symptoms despite evidence of endoscopic remission among adults with Crohn disease (CD), according to study results presented at the Advances in Inflammatory Bowel Diseases (AIBD) 2022 conference, held from December 5 to 7, 2022, in Orlando, Florida.

Researchers conducted a retrospective cohort study to assess the relationship between the symptomatic and inflammatory burden of CD and social determinants of health.

Social determinants of health include community conditions, neighborhood environments, job opportunities, education levels, dietary resources, transportation, and other socioeconomic factors.

Researchers used the California Healthy Places Index to determine health disadvantages (low scores on the index) from health advantages (higher scores) classified into 8 subdomains. These 8 categories included economy, education, health care access, housing, neighborhoods, clean environment, transportation, and social environment.  

Of particular interest was the effect these social determinants of health had on patients with and without active GI symptoms despite evidence of endoscopic remission of CD.

Researchers obtained evidence of endoscopic remission by including patients with CD within 7 days of undergoing an ileocolonoscopy and receiving a score of less than 3 on the Simple Endoscopic Score for Crohn’s Disease, indicating remission.

Further investigations into the role of social determinants of health and environmental risk factors in the clinical course and manifestation of IBD [inflammatory bowel disease] are warranted.

Approximately 353 ileocolonoscopies for 216 different patients with CD occurred, with 108 patients having achieved endoscopic remissions as evidenced by 151 ileocolonoscopies (43%).

The patients also underwent standard clinical disease activity assessments, such as the 2-item patient-reported outcome (PRO-2) for abdominal pain (AP) and stool frequency (SF). Scores of 3 or less on the PRO-2 AP and 1 or less on the PRO-2 SF indicated clinical remission of CD.

Health disadvantage did not correspond to endoscopic disease activity levels (P =.95) because 42% of individuals with CD who achieved endoscopic remission ranked below the median index score for the social determinants of health, while 43% who achieved endoscopic remission of CD ranked above the median index score.

However, patients with health disadvantage more commonly reported persistent GI symptoms despite endoscopic remission (odds ratio [OR], 2.7; 95% CI, 1.1-6.5; P =.03).

When comparing just one factor at a time, socioeconomic factors that increased risk for persistent GI symptoms included poor economic conditions (OR, 2.4; 95% CI, 1.0-5.7; P =.04), lower educational status (OR, 3.9; 95% CI, 1.8-8.2; P =.0004), unfavorable neighborhood conditions (OR, 3.1; 95% CI, 1.6-6.3; P =.001), and poor access to health care services (OR, 2.3; 95% CI, 1.1-4.4; P =.02). Other risk factors included female sex (OR, 2.8; 95% CI, 1.4-5.7; P =.003) and smoking (OR, 2.6; 95% CI, 1.2-5.8; P =.02).

Comparing multiple variables simultaneously, female sex (adjusted odds ratio [aOR], 2.8; 95% CI, 1.3-6.5; P =.01), smoking (aOR, 2.6; 95% CI, 1.1-6.4; P =.02), and unfavorable neighborhood conditions (aOR, 2.9; 95% CI, 1.3-6.5; P =.01) remained independent predictors of persistent GI symptoms, regardless of the patient achieving endoscopic remission.

“Health disadvantage, specifically poor neighborhood conditions, may be non-inflammatory risk factors for persistent gastrointestinal symptoms of adults with Crohn’s disease in endoscopic remission,” the study authors wrote. “Further investigations into the role of social determinants of health and environmental risk factors in the clinical course and manifestation of IBD [inflammatory bowel disease] are warranted.”


Tse CS, Nguyen H, Yonan A, et al. Health disadvantage is associated with persistent GI symptoms in adults with Crohn’s disease in endoscopic remission. Abstract presented at: AIBD 2022; December 5-7, 2022; Orlando, FL. Abstract 48.