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Minority Pediatric Patients with Inflammatory Bowel Disease Demonstrate an Increased Length of Stay
Edward L Barnes1, Bharati Kochar, Millie D Long
1*Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;†Center for Gastrointestinal Biology and Disease, Chapel Hill, North Carolina; and‡Division of Pediatric Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Insights
Racial disparities exist in pediatric inflammatory bowel disease (IBD) care. Black and Hispanic children with Crohn's disease (CD) and Hispanic children with ulcerative colitis (UC) experienced longer hospital stays, indicating potential inequities in management.
Area of Science:
- Pediatric gastroenterology
- Health services research
- Health equity
Background:
- Inflammatory bowel disease (IBD) management in children can vary by race, influenced by biological factors and healthcare delivery disparities.
- Understanding these differences is crucial for improving pediatric IBD care.
- Previous research has not fully elucidated racial disparities in IBD patient management.
Purpose of the Study:
- To investigate racial differences in the management of pediatric inflammatory bowel disease (IBD).
- Specifically, to analyze the impact of race on length of stay (LOS) for children with Crohn's disease (CD) and ulcerative colitis (UC).
Main Methods:
- Cross-sectional analysis of the Kids' Inpatient Database (2000-2012).
- Inclusion of pediatric patients (≤18 years) diagnosed with CD or UC.
- Multivariable logistic regression to assess the relationship between race and LOS, controlling for covariates.
Main Results:
- Analysis of 27,295 pediatric IBD hospitalizations (62% CD, 38% UC).
- Black and Hispanic children with CD had significantly increased odds of longer LOS compared to white children.
- Hispanic children with UC also showed increased odds of longer LOS compared to white children.
Conclusions:
- Racial disparities in length of stay persist for pediatric IBD patients.
- Black and Hispanic children with CD, and Hispanic children with UC, experience longer hospitalizations than their white counterparts.
- Factors contributing to these disparities may include provider/hospital characteristics, socioeconomic status, and biological differences.
Background:
Genetic and other biological factors may lead to differences in disease behavior among children with inflammatory bowel disease of different races, which may be further modified by disparities in care delivery. Using the Kids' Inpatient Database, we aimed to evaluate differences in the management of pediatric patients with inflammatory bowel disease by race, focusing on length of stay (LOS).
Methods:
We performed a cross-sectional analysis using 2000 to 2012 data from the Kids' Inpatient Database, a nationally representative database. We identified pediatric patients (≤18 years of age) with discharge diagnoses of Crohn's disease (CD) or ulcerative colitis (UC). We used multivariable logistic regression to evaluate the relationship between race and LOS, controlling for age, payer status need for surgery, and year of admission.
Results:
We identified 27,295 hospitalizations for children with inflammatory bowel disease (62% CD and 38% UC), Compared with white patients with CD, black (adjusted odds ratio 1.37; 95% confidence interval, 1.22-1.53; P < 0.001) and Hispanic patients (adjusted odds ratio: 1.37; 95% confidence interval: 1.19-1.59; P < 0.001) with CD demonstrated increased odds of a LOS greater than the 75th percentile. When compared with white patients with UC, Hispanic patients also demonstrated increased odds of a LOS greater than the 75th percentile (adjusted odds ratio: 1.20; 95% confidence interval, 1.02-1.42, P = 0.015).
Conclusions:
After controlling for age, year of admission, and clinical phenotypes, black and Hispanic patients with CD and Hispanic patients with UC had longer LOS than white patients. These may be due to differences in provider/hospital characteristics, socioeconomic differences, and/or differences in genetics and other biological factors (see Video Abstract, Supplemental Digital Content 1, http://links.lww.com/IBD/B656).
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