Study Reveals Racial Disparities in IBD Healthcare

TOPLINE:

Among individuals with inflammatory bowel disease (IBD), Asian and Hispanic American individuals had lower healthcare utilization than White American individuals, whereas Black American adults aged 65 years or older had higher use of emergency department utilization.

METHODOLOGY:

• Although IBD is more common among White American individuals, Black and Hispanic individuals face greater challenges in accessing IBD care and are more likely to use emergency services.
• Researchers conducted a retrospective cohort study using data from Optum’s Clinformatics Data Mart Database (CDM; 2000-2018) and Medicare (2007-2017) to examine racial and ethnic disparities in healthcare utilization among patients with IBD.
• Participants were categorized by disease type (Crohn’s disease, ulcerative colitis, or IBD not otherwise specified) and age groups: Children (< 20 years), adults (20-64 years), and older adults (≥ 65 years).
• Measures of healthcare utilization during 2017 included medications dispensed, outpatient encounters, emergency department visits, hospitalizations, surgeries, lower endoscopy, and cross-sectional imaging.

TAKEAWAY:

• The study included 47,301 patients from the CDM cohort and 34,873 patients from the Medicare cohort. Most patients in the CDM and Medicare cohorts were White (82% and 89%, respectively), with smaller proportions identifying as Asian (3% and 2%), Black (8% and 5%), and Hispanic (7% and 4%).
• Among those aged 20-64 years, Asian American adults had a lower use of advanced IBD therapies (odds ratio [OR], 0.69); Hispanic American adults also used fewer advanced therapies (OR, 0.74) and had fewer visits to the gastroenterologist (OR, 0.84).
• Working-age Black American adults were more likely to receive steroids and require emergency services and hospitalization for IBD than White American adults; however, these disparities vanished after adjusting for socioeconomic factors.
• Among those aged 65 years or older, Black American adults had greater emergency department use for IBD management (OR, 1.41) but lower steroid use (OR, 0.77) than their White counterparts; older Hispanic American adults exhibited lower healthcare utilization, with decreased glucocorticoid use.
• Hispanic children underwent more diagnostic endoscopy and imaging than White children, suggesting more complex disease presentations, yet they were not more likely to receive advanced therapies.

IN PRACTICE:

“These findings underscore the need for efforts to improve access and quality of IBD care for historically marginalized populations. Further research is needed to inform future healthcare and policy interventions that eliminate racial disparities and achieve health equity among all patients with IBD,” the authors wrote.

SOURCE:

The study was led by Abraham Segura, MD, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, and published online in The American Journal of Gastroenterology.

LIMITATIONS:

This study relied on proprietary algorithms to classify race according to patient geography and name, which may have introduced misclassification bias. The analysis did not include Medicaid beneficiaries younger than 65 years from historically marginalized populations, potentially underestimating disparities among those with other insurance plans or no insurance. The analysis was limited to a single year, which may not accurately capture longitudinal changes in healthcare coverage and utilization.

DISCLOSURES:

This study was funded by the Centers for Disease Control and Prevention, with additional support provided by the Biomedical Data Science Core. Three authors reported having stocks, receiving research funding and educational grants, and other ties with several pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.