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Racial Disparities in Pediatric Inflammatory Bowel Disease Care: Differences in Outcomes and Health Service
Julia Smith1, Chunyan Liu2, Andrew Beck3
1Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Insights
Racial disparities exist in pediatric inflammatory bowel disease (IBD) care, with Black children less likely to achieve remission. Insurance status partially explains these differences, highlighting the need to address social determinants of health in IBD treatment.
Area of Science:
- Pediatric Gastroenterology
- Health Services Research
- Health Equity
Background:
- Racial inequities in pediatric inflammatory bowel disease (IBD) care are a significant concern.
- Understanding the drivers of these disparities is crucial for improving patient outcomes.
Purpose of the Study:
- To describe racial inequities in pediatric IBD care.
- To explore potential drivers of these disparities, including insurance status and health service utilization.
Main Methods:
- A single-center, comparative cohort study of newly diagnosed Black and non-Hispanic White patients (<21 years) with IBD.
- Outcomes assessed included corticosteroid-free remission (CSFR) at 1 year, sustained CSFR, time to anti-tumor necrosis factor therapy, and health service utilization.
Main Results:
- Black patients were less likely to achieve 1-year CSFR (OR: 0.52) and sustained CSFR (OR: 0.48).
- These differences were not significant when adjusted for insurance type.
- Black patients had fewer gastroenterology visits and increased emergency department visits, but no differences in biologic therapy or surgical outcomes were observed.
Conclusions:
- While phenotypic presentation and medication usage did not differ by race, Black pediatric IBD patients had lower odds of achieving remission, partly mediated by insurance status.
- Further research into social determinants of health is necessary to fully understand and address these racial inequities in IBD care.
Objective:
To describe racial inequities in pediatric inflammatory bowel disease care and explore potential drivers.
Methods:
We undertook a single-center, comparative cohort study of newly diagnosed Black and non-Hispanic White patients with inflammatory bowel disease, aged <21 years, from January 2013 through 2020. Primary outcome was corticosteroid-free remission (CSFR) at 1 year. Other longitudinal outcomes included sustained CSFR, time to anti-tumor necrosis factor therapy, and evaluation of health service utilization.
Results:
Among 519 children (89% White, 11% Black), 73% presented with Crohn's disease and 27% with ulcerative colitis. Disease phenotype did not differ by race. More patients from Black families had public insurance (58% vs 30%, P < .001). Black patients were less likely to achieve CSFR 1-year post diagnosis (OR: 0.52, 95% CI:0.3-0.9) and less likely to achieve sustained CSFR (OR: 0.48, 95% CI: 0.25-0.92). When adjusted by insurance type, differences by race to 1-year CSFR were no longer significant (aOR: 0.58; 95% CI: 0.33, 1.04; P = .07). Black patients were more likely to transition from remission to a worsened state, and less likely to transition to remission. We found no differences in biologic therapy utilization or surgical outcomes by race. Black patients had fewer gastroenterology clinic visits and 2-fold increased odds for emergency department visits.
Conclusions:
We observed no differences by race in phenotypic presentation and medication usage. Black patients had half the odds of achieving clinical remission, but a degree of this was mediated by insurance status. Understanding the cause of such differences will require further exploration of social determinants of health.
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