as vigorously active. None of the following clinical factors showed association with the PAL, whether as a continuous variable or according to the MVPA cutoff: disease phenotype and activity, abdominal pain, anemia, arthralgia, arthritis, age at diagnosis and age at visit. As for familial factors, no association was found between parents' BMI and patients' PAL. Moreover, patients in the vigorously active group had the lowest BMI as compared to patients in moderately active and sedentary groups, with respective median (interquartile range (IQR)) BMIs of 19.8(18.3 - 21.3), 22.4(20.3 - 24.4), and 20.4(18.9 - 23.3) kg/m 2 P=0.0243. Conclusions: Our study showed no association between clinical or familial factors and PAL in pediatric IBD patients. Thus, further physical activity recommendations from health providers are needed to help enhance PAL in all children diagnosed with IBD regardless of disease activity. Mo1772 INCREASED HEALTHCARE UTILIZATION BY MEDICAID PATIENTS WITH INFLAMMATORY BOWEL DISEASE Jordan E. Axelrad, Rajani Sharma, Monika Laszkowska, Richard M. Rosenberg, Benjamin Lebwohl Background: Low socioeconomic status has been linked with numerous poor health out- comes, but there is little data regarding the impact of insurance status on inflammatory bowel disease (IBD) outcomes. We aimed to characterize utilization of healthcare resources by IBD patients based on health insurance status, using Medicaid enrollment as a proxy for low socioeconomic status. Methods: We identified all adult patients with IBD engaged in a colorectal cancer surveillance colonoscopy program at an urban, quaternary care center from January 2007 to June 2017. We retrospectively reviewed medical records for demographics, insurance status, and IBD-associated variables. Our primary outcomes included IBD-related emergency department (ED) visits, inpatient hospitalizations, biologic infusions, and steroid exposure, stratified by insurance status. We compared patients who had ever been enrolled in Medicaid to all other patients. Results: Of 947 patients with IBD engaged in a colorectal cancer surveillance colonoscopy program, 221 (23%) ever had Medicaid (Table 1). Compared to other insurances, Medicaid patients had significantly higher rates of ever being admitted to the hospital (78% vs. 43%, p=0.001) or ever visiting the ED (91% vs. 38%, p=0.001). When adjusted for sex, age at first colonoscopy, race, and ethnicity, Medicaid patients had a higher rate of inpatient hospitalizations (Rate ratio [RR] 2.95; 95% CI 2.59-3.36) and ED visits (RR 4.24; 95% CI 3.82-4.70) compared to patients with other insurance (Table 2). Medicaid patients had significantly higher prevalence of requiring steroids (62% vs. 38%, p=0.001) and after adjusting for sex, age at first colonoscopy, race, and ethnicity, the odds of requiring steroids in the Medicaid population was increased (OR 3.77; 95% CI 2.53- 5.62). Conclusions: Medicaid insurance was a significant predictor of IBD care and outcomes. While Medicaid is designed to improve healthcare quality and minimize the impact of social determinants of health, these data suggest that patients with IBD who ever required Medicaid may have less engagement in IBD care and seek emergency care more often. ED providers may perceive substantial barriers in this population in accessing maintenance IBD care and therapies, and be more likely to admit for hospitalization and/or prescribe steroids, management strategies with fewer perceived barriers. This study highlights the need to change healthcare models to better serve the growing needs of patients with IBD. S-833 AGA Abstracts Mo1773 COST DRIVERS AND TRENDS IN INFLAMMATORY BOWEL DISEASES K. T. Park, Orna G. Ehrlich, John I. Allen, Perry Meadows, Eva Szigethy, Kimberlee Henrichsen, Sandra C. Kim, Rachel Lawton, Sean Murphy, Miguel D. Regueiro, David T. Rubin, Nicole M. Engel-Nitz, Caren Heller Background: The Crohn's & Colitis Foundation's Cost of Inflammatory Bowel Disease (IBD) Care Initiative seeks to quantify the wide-ranging healthcare costs affecting patients living with IBD. We aimed to (1) describe the annualized direct and indirect costs of care for patients with Crohn's disease (CD) or ulcerative colitis (UC), (2) determine the longitudinal drivers of these costs, and (3) characterize the cost of care for newly diagnosed patients. Methods: We analyzed the Optum Research Database from the years 2007 to 2016, represent- ing commercially- and Medicare Advantage-insured patients in the United States. Inclusion for the study was limited to those who had continuous enrollment with medical and pharmacy benefit coverage for at least 24 months (12 months prior through 12 months after the index date of diagnosis). Workplace productivity loss was calculated as number of hours lost due to health care encounters multiplied by the patients' estimated average wage derived from the Bureau of Labor Statistics. Comparisons between IBD patients and non-IBD patients were analyzed based on demographics, health plan type, and length of follow-up. We used generalized linear models to estimate the association between total annual costs and various patient variables. Results: There were 52,782 IBD patients (29,062 UC; 23,720 CD) included in the analysis (54.1% females). On a per-annual basis, patients with IBD incurred over a three-fold higher direct cost of care compared to non-IBD controls ($22,987 vs $6,956 per- member per-year paid claims) and more than twice the out-of-pocket costs ($2,213 vs $979 per-year reported costs) (Figure 1), with all-cause IBD costs rising after 2013 (Figure 2). Patients with IBD also experienced significantly higher costs associated with workplace productivity losses as compared to controls. The study identified several key drivers of cost for IBD patients: treatment with specific therapeutics (biologics, narcotics, or steroids), emergency department use, and healthcare service utilization associated with relapsing disease, anemia, or mental health condition. Additionally, the study found that annual costs of care were highest during the first year of the initial IBD diagnosis (mean >$25,000). Conclusion: The costs of care for IBD have increased in the last 5 years and are driven by specific therapeutics and disease features. In addition, compared to non-IBD controls, IBD patients are increasingly incurring higher costs associated with healthcare utilization, out- of-pocket expenditures, and workplace productivity losses. There is a pressing need for cost-effective strategies to address these burdens on patients and families affected by IBD. Figure 1. Yearly Cost by Site of Service and Patient Costs AGA Abstracts