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Hispanic Patients with Primary Biliary Cholangitis Have Decreased Access to Care Compared to Non-Hispanics
Atoosa Rabiee1, Nathalie A Pena Polanco2, Aymara Fernandez De La Vara3
1Department of Gastroenterology and Hepatology, VA Medical Center, Washington DC, USA.
Insights
Hispanic patients with primary biliary cholangitis (PBC) show worse outcomes with ursodeoxycholic acid (UDCA) treatment. Socioeconomic factors, not environmental exposures, likely contribute to these disparities.
Area of Science:
- Hepatology
- Gastroenterology
- Clinical Research
Background:
- Primary biliary cholangitis (PBC) disproportionately affects Hispanic patients, with poorer biochemical response to ursodeoxycholic acid (UDCA) and increased disease progression.
- Understanding demographic, comorbidity, environmental, and socioeconomic differences is crucial for addressing health disparities in PBC.
Purpose of the Study:
- To investigate the demographic, comorbidity, environmental, and socioeconomic factors differentiating Hispanic and non-Hispanic PBC patients.
- To identify potential reasons for observed differences in treatment response and disease progression.
Main Methods:
- A case control study analyzed data from Hispanic and non-Hispanic PBC patients at a single academic center.
- Data were collected via questionnaires assessing demographics, comorbidities, environmental exposures, and socioeconomic status.
- Odds ratios were calculated to determine associations between patient characteristics and PBC outcomes.
Main Results:
- Baseline demographics, environmental factors, and comorbidities were similar between Hispanic and non-Hispanic PBC patients.
- Hispanic patients reported lower marriage rates, less than high school education, lower household income (<$50,000), and reduced health insurance coverage.
- Health insurance coverage was significantly lower in Hispanic patients (86.5%) compared to non-Hispanic patients (98.1%).
Conclusions:
- Socioeconomic factors, including lower income and reduced health insurance access, appear to contribute to disparities in PBC outcomes for Hispanic patients.
- Observed differences in disease severity and UDCA response are not explained by environmental exposures alone.
- Addressing socioeconomic discrepancies and improving access to care may be vital for mitigating health disparities in Hispanic PBC patients.
Abstract:
Hispanic patients with primary biliary cholangitis (PBC) have reduced rates of biochemical response to ursodeoxycholic acid (UDCA) and increased risk of disease progression compared to non-Hispanic patients. In this study, we sought to identify differences in demographics, comorbidities, environmental risk factors and socioeconomic status between Hispanic and non-Hispanic patients with PBC. In a case control study, we analyzed data from Hispanic (n=37 females and 1 male) and non-Hispanic (n=54 females and 4 males) patients with PBC seen at the University of Miami/Jackson Memorial Hospital from January 1998 through January 2013. Data were obtained by filling out a questionnaire either via phone call, mail, or e-mail. Odds ratios were calculated to measure the association between exposure and outcomes. Baseline demographics, environmental risk factors and comorbidities were similar between Hispanic and non-Hispanic patients with PBC. Hispanic patients were less likely to be married and fewer Hispanics had education beyond high school level compared to non-Hispanics. Sixty four percent of Hispanic patients had a household income of less than $50000, compared to 19.5% of non-Hispanics. Fewer Hispanic patients with PBC had health insurance coverage compared to non-Hispanics (86.5% vs. 98.1%; odds ratio: 0.1, 95% confidence interval: 0-0.9). Differences in disease severity and response to therapy observed in prior studies could not be explained by environmental exposures. In addition to genetic variation, socioeconomic discrepancies (access to care) may further explain these differences.
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