Racial, Ethnic Disparities Influence IBD-Related Health Care Utilization

Racial and ethnic disparities in health care use among patients with inflammatory bowel disease (IBD) may be due to limited health care access and socioeconomic factors, according to study findings in Inflammatory Bowel Diseases.

Researchers conducted a systematic review and meta-analysis to assess the effect of race and ethnicity on IBD-related health care utilization. For the analysis, researchers sourced data from studies that evaluated the social determinants of health in patients with IBD. Exclusion criteria were case reports, case series, and systematic reviews. 

The primary outcome was the difference in health care utilization among people of different races and ethnicities. Health care utilization included IBD-related operations, hospitalizations, readmissions following discharge from IBD-related procedures or surgical hospitalization, and emergency department visits.

A total of 58 retrospective, observational studies were included in the analysis. A majority of studies (41, 70.6%) including Asian patients revealed that they were not at an increased risk of undergoing Crohn disease (CD) or ulcerative colitis (UC)-related operations when compared with White patients (odds ratio [OR], 0.60; 95% CI, 0.43-0.83).  

Mexican American patients were less likely to undergo UC-related operations compared with White patients (pooled OR, 0.24; 95% CI, 0.08-0.77; I²=0%). South Asian patients were less likely to receive CD-related operations but were more likely to receive a UC-related operation when compared with White patients.

There were no significant differences in IBD-related surgical procedures between White and Pakistani patients, White and Bangladeshi patients, and Middle Eastern and non-Middle Eastern patients.

Black patients had an increased risk for IBD-related hospitalization (pooled OR, 1.54; 95% CI, 1.06-2.24; I²=77.0%) and emergency department visits (OR, 1.74; 95% CI, 1.32-2.30; I²=0%) when compared with White patients.

There were no significant differences observed for IBD-related hospitalizations among Asian (pooled OR, 0.34; 95% CI, 0.02-7.40; I²=95.0%) and South Asian (pooled OR, 1.09; 95% CI, 0.47-2.53; I²=60.0%) patients when compared with White patients.

The 30-day readmission rate following IBD-related surgery was similar among White and Black patients. However, when assessing these patients at 12 months, there was a greater likelihood that Black patients would be readmitted following IBD surgery (pooled OR, 1.41; 95% CI, 1.09- 1.82; I²=41.0%).

Hispanic patients had a greater likelihood of being readmitted 30 days after IBD surgery when compared with non-Hispanic patients.

Study limitations are the inability to fully define disease characteristics, the lack of socioeconomic information reported, and the inability to determine the influence of dietary habits on health care utilization. 

“A significant contributor between the observed differences in hospitalization rates between racial and ethnic groups could be driven by access to care,” the study authors noted. “Maintenance of disease remission requires multidisciplinary care and close monitoring of endoscopic disease severity and clinical status.”