Social deprivation does not impact on acute pancreatitis severity and mortality: a single-centre study

Background and aims The incidence of acute pancreatitis (AP) is increasing in the UK. Patients with severe AP require a significant amount of resources to support them during their admission. The ability to predict which patients will develop multiorgan dysfunction remains poor leading to a delay in the identification of these patients and a window of opportunity for early intervention is missed. Social deprivation has been linked with increased mortality across surgical specialties. Its role in predicting mortality in patients with AP remains unclear but would allow high-risk patients to be identified early and to focus resources on high-risk populations. Methods A prospectively collected single-centre database was analysed. English Index of Multiple Deprivation (IMD) was calculated based on postcode. Patients were grouped according to their English IMD quintile. Outcomes measured included all-cause mortality, Intestive care unit (ITU) admission, overall length of stay (LOS) and local pancreatitis-specific complications. Results 398 patients with AP between 2018 and 2021 were identified. There were significantly more patients with AP in Q1 (IMD 1–2) compared with Q5 (IMD 9–10) (156 vs 38, p<0.001). Patients who were resident in the most deprived areas were significantly younger (52.4 in Q1 vs 65.2 in Q5, p<0.001), and more often smokers (39.1% in Q1 vs 23.7% in Q5, p=0.044) with IHD (95.0% vs 92.1% in Q5, p<0.001). In multivariate modelling, there was no significance difference in pancreatitis-related complications, number of ITU visits, number of organs supported and overall, LOS by IMD quintile. Conclusions Although there was a significantly higher number of patients admitted to our unit with AP from the most socially deprived quintiles, there was no correlation between social economic deprivation and mortality following AP.

[1]  J. Logue,et al.  Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis , 2021, BMJ open gastroenterology.

[2]  M. Marmot,et al.  Association between socioeconomic status and the development of mental and physical health conditions in adulthood: a multi-cohort study. , 2020, The Lancet. Public health.

[3]  D. Mole,et al.  Survival and new-onset morbidity after critical care admission for acute pancreatitis in Scotland: a national electronic healthcare record linkage cohort study , 2018, BMJ Open.

[4]  Gregory T. Jones,et al.  Survival Disparity Following Abdominal Aortic Aneurysm Repair Highlights Inequality in Ethnic and Socio-economic Status. , 2017, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[5]  A. Shaaban,et al.  Revised Atlanta Classification for Acute Pancreatitis: A Pictorial Essay. , 2016, Radiographics : a review publication of the Radiological Society of North America, Inc.

[6]  D. Cromwell,et al.  Socioeconomic deprivation and inpatient complication rates following mastectomy and breast reconstruction surgery , 2015, The British journal of surgery.

[7]  B. Bridgewater,et al.  Is social deprivation an independent predictor of outcomes following cardiac surgery? An analysis of 240 221 patients from a national registry , 2015, BMJ Open.

[8]  Maxine Weinstein,et al.  Socioeconomic Status and Biological Markers of Health , 2015, Journal of aging and health.

[9]  S. Roberts,et al.  Mortality following acute pancreatitis: social deprivation, hospital size and time of admission: record linkage study , 2014, BMC Gastroenterology.

[10]  H. van den Bussche,et al.  The influence of age, gender and socio-economic status on multimorbidity patterns in primary care. first results from the multicare cohort study , 2012, BMC Health Services Research.

[11]  M. Goldacre,et al.  Incidence and case fatality for acute pancreatitis in England: geographical variation, social deprivation, alcohol consumption and aetiology – a record linkage study , 2008, Alimentary pharmacology & therapeutics.

[12]  S. Pocock,et al.  Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies , 2007, BMJ : British Medical Journal.

[13]  A. Edwards,et al.  Gastroenterology services in the UK. The burden of disease, and the organisation and delivery of services for gastrointestinal and liver disorders: a review of the evidence , 2007, Gut.

[14]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.