Association of Race and Ethnicity with Healthcare Utilization for Inflammatory Bowel Disease in the United States: A Retrospective Cohort Study.

Abstract

Introduction: Advances in medical and surgical therapy have improved the outlook for those affected with Crohn's disease and ulcerative colitis; however, it is unclear if Americans from marginalized racial and ethnic backgrounds have adequate and equitable access to care for inflammatory bowel disease. We evaluated the association between race and ethnicity and healthcare utilization in patients diagnosed with inflammatory bowel disease.

Methods: This study identified children and adults diagnosed with inflammatory bowel disease in two national data sets from 2016 to 2017. We modeled the association between healthcare utilization and racial and ethnic subpopulations across different age groups using generalized estimating equations adjusted by disease and socioeconomic factors.

Results: Among working-age adults, Black Americans had higher emergency department, hospitalization, and steroid use than White patients, however these differences were attenuated after adjusting for socioeconomic factors. Asian and Hispanic Americans were less likely to receive outpatient gastroenterological care and medical therapy even after adjustment. Emergency department use was more likely among elderly Black patients. Hispanic children had increased healthcare utilization for inflammatory bowel disease compared to White children, though these results did not meet statistical significance.

Discussion: Healthcare utilization for long-term management of inflammatory bowel disease is lower in historically marginalized racial and ethnic groups compared to White Americans. Further research is needed to identify and address modifiable patient, clinician, and healthcare system barriers to achieve health equity in the management of inflammatory bowel disease.