EP759 - Diverticulitis in Native Americans: Trends in New Mexico

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Purpose/Background: Diverticulitis is one of the most common gastrointestinal indications for hospital admission nationwide. Current literature reflects that the presentation and outcomes of diverticulitis vary by race and ethnicity. Despite prior studies showing a high prevalence of risk factors for diverticulitis among Native Americans (obesity, tobacco use, low intake of fresh fruits and vegetables, low physical activity), no studies have specifically evaluated diverticulitis trends in Native Americans. New Mexico has one of the largest Indigenous populations in the United States, with approximately 11% of residents identifying as such in the 2020 US Census. We sought to characterize the presentation and outcomes of diverticulitis in Native Americans compared to other populations in New Mexico, hypothesizing that outcomes would vary based on race and socioeconomic factors.

Methods/Interventions: A single-institution, retrospective chart review was performed to identify patients treated for diverticulitis at a tertiary academic center and an auxiliary hospital campus in New Mexico between 2012 and 2021. All charts with ICD codes for diverticulitis were reviewed to collect data on demographics, co-morbidities, and clinical outcomes. The EPA Environmental Justice Screen (US EPA 2020 version) was used to calculate the demographic index (DI) and supplemental demographic index (SDI), measures that identify community-level vulnerability, for each patient based on their home zip code. Factors that contribute to community-level vulnerability include poverty, unemployment, and low education, all of which affect a community’s ability to withstand external stressors. Higher DI and SDI percentiles are associated with increased vulnerability. Data was analyzed through descriptive statistics, independent-samples Kruskal-Wallis tests, and bivariate analysis.

Results/Outcomes: Of the 885 patients included in the analysis, 112 (12.7%) identified as Native American. Native Americans had a significantly lower mean age at diagnosis (49.5 years versus 56.8 years, p< 0.05) and higher rates of emergent surgery for diverticulitis (76.7% versus 58.6% overall) compared to the rest of the patient population. Native Americans had higher rates of postoperative complications (33% versus 18% overall), despite having similar comorbidities upon presentation. Native Americans had a significantly higher SDI percentile when compared to White or Hispanic/Latino groups (P69 versus P60 versus P64, p< 0.05), indicating increased community-level vulnerability. There was a significant trend towards earlier age of diagnosis with higher DI and SDI overall (p < 0.05) [Figure 1]. No differences in severity of disease at presentation were found between groups. The groups had similar rates of surgical management, ostomy creation, and ostomy reversal.

Conclusion/Discussion: Our study is the largest study to evaluate trends in diverticulitis in Native Americans. The finding of diverticulitis at younger ages in the Indigenous population is associated with increased vulnerabilities from socioeconomic factors. Environmental factors that increase the risk of diverticulitis, such as lack of access to dietary fiber and clean water, are also related to a multitude of benign and malignant colon pathologies. As colorectal surgeons work to address these diseases as a whole, these factors must be kept at the forefront when considering prevention efforts and interventions.