The impact of ethnicity on delays in initiating advanced therapy for inflammatory bowel disease

Prompt initiation of advanced therapy medications, encompassing biologics and small-molecule treatments, is crucial for the effective management of inflammatory bowel disease (IBD). The time taken from the decision to start an advanced therapy to the first administration, or time to advanced therapy (TAT), can vary significantly between individuals and negatively affect disease course; however, our knowledge of the causes of variation in TAT is poor. We aimed to investigate the impact of demographic factors on delays in TAT.

A retrospective study, conducted at a tertiary IBD referral centre, analysed electronic patient records of 1298 patients with IBD, and collected data on the TAT for their index advanced therapy. The variables studied included disease type, treatment, age, sex, ethnicity, and socioeconomic status, using index of multiple deprivation. Multiple negative binomial regression was performed to assess the relative effects of these variables on TAT.

TAT was significantly longer in the non-White ethnicity group ( P  = 0.039). Patients of Black ethnicity had an incident rate ratio (IRR) of 1.46 [95% confidence interval (CI): 1.09-1.95], for mixed ethnicity IRR = 1.26 (95% CI: 0.77-2.05) and for Asian IRR = 1.17 (95% CI: 0.96-1.41) compared with White patients. Adalimumab was also associated with a longer TAT ( P  ≤ 0.001; IRR = 1.37; 95% CI: 0.95-1.96).

Non-White ethnicity is associated with a longer TAT, as is treatment with adalimumab which may be because of outsourcing of medication supply. Further research on the causes and strategies to address this health disparity is required.