Disparities in the Diagnosis and Management of Crohn’s Perianal Fistulas

Cropped shot of an attractive young woman lying on her sofa alone and suffering from period cramps at home. Ouch! My tummy! Woman with menstrual pain
Investigators assessed disparities in the care and disease education needs of patients with Crohn’s perianal fistulas.

The following article is a part of conference coverage from the Advances in Inflammatory Bowel Diseases 2021 Annual Meeting , held from December 9 to 11, 2021. The team at Gastroenterology Advisor will be reporting on the latest news and research conducted by leading experts in gastroenterology. Check back for more from AIBD 2021.


Disparities in care quality and timing persist between White and non-White patients with Crohn’s perianal fistulas (CPF), according to research presented at the Advances in Inflammatory Bowel Diseases (AIBD) 2021 Annual Meeting, held from December 9 to 11, 2021, in Orlando, Florida and virtually.

To better illustrate disparities in CPF care and management, investigators administered a survey to patients and caregivers around the United States between September and October of 2020. The survey asked respondents to report demographic characteristics, insurance status, disease status, time from first symptom emergence to CPF diagnosis, and surgical history. Patients were also asked to report their satisfaction with a number of care aspects.

A total of 148 responses from patients and caregivers were collected. Of these, just 28 were from non-White individuals, including American Indian/Alaskan Native, Black/African American, Hispanic/Latino, Native Hawaiian/Pacific Islander, and multiracial patients (n=12) and caregivers (n=16). The mean ages of the survey participants were 32 years for non-White patients and 35 years for White patients.

Insurance coverage varied, with non-White patients primarily covered by Medicare/Medicaid (68%) and White patients primarily covered by private insurance (64%).

Non-White respondents experienced a longer mean time between symptom onset and CPF diagnosis compared with White respondents (2.08 years vs <1 year). White respondents were also more likely to report current biologics use vs non-White respondents (50% vs 36%). Among patients who had undergone surgery, those who were White had undergone a higher mean number of procedure types compared with those who were not White (2.31 vs 1.64 types).

Non-White respondents were less likely to agree that they were satisfied with their current quality of care (39% vs 72%) and accessibility of care (57% vs 69%) than White respondents. Overall, just 50% of non-White patients/caregivers and 69% of White patients/caregivers agreed that they knew where to find CPF-related information. The majority of all patients agreed that barriers to CPF care included inadequate community social services, high out-of-pocket costs, limited information on CPF, physical/emotional stress from managing CPF, and lack of access to specialist care and/or effective treatment (all >70%).

Per these data, race/ethnicity-based disparities persist in the treatment of CPF. In particular, non-White patients experienced longer time between symptom onset and diagnosis, received fewer surgery, and were more likely to be dissatisfied with care quality and accessibility. “Further research into disparities in the management of CPF is needed, as is CPF education for patients/caregivers and [health care provider] education on managing CPF in minority populations,” investigators concluded.

Visit Gastroenterology Advisor’s meetings section for complete coverage of AIBD 2021.



Salinas G, Belcher E, Cazzetta S, Pradeep N, Sylvie S. Disparities in diagnosis and management of patients with Crohn’s perianal fistulas: results of a US national patient and caregiver survey. Presented at: AIBD 2021 Annual Meeting; December 9-11, 2021; Orlando, FL and virtual. Abstract P036.