Racial disparity in inflammatory bowel disease-related complications: a nationwide cohort study

Racial disparities in inflammatory bowel disease (IBD)-related complications are increasingly recognized, yet nationwide data remain limited. This study examined racial differences in IBD-related complications across diverse patient populations.

We analyzed data from the Nationwide Inpatient Sample 2016-2021, on over 1.7 million weighted hospitalizations for IBD. Adults with Crohn's disease (CD) or ulcerative colitis (UC) were identified using ICD-10 codes. Key outcomes included anal abscess, intestinal obstruction, rectal bleeding and anal fissure/fistula, were compared across racial groups. Multivariate logistic regression was used to estimate the odds of complications, adjusting for age, sex, insurance, comorbidities, and hospital factors.

Compared to White patients, Black and Hispanic patients with CD had higher rates of anal abscesses (2.8% and 2.57% vs. 1.25%) and rectal bleeding (2.85% and 2.51% vs. 1.79%). Multivariate logistic regression showed that Black and Asian patients had higher odds of developing anal abscess compared to White patients (adjusted OR [aOR] 1.41, 95% confidence interval [CI] 1.38-1.45] and aOR 1.19, 95%CI 1.13-1.29, respectively). In UC, Black (aOR 1.33, 95%CI 1.29-1.37), Hispanic (aOR 1.23, 95%CI 1.21-1.27), and Asian patients (aOR 1.12, 95%CI 1.04-1.20) had higher odds of rectal bleeding, while the odds of intestinal obstruction were lower in Black (aOR 0.74, 95%CI 0.67-0.82), compared to White patients.

Racial disparities exist in complications associated with IBD. Black and Hispanic patients had higher odds of perianal complications, while White patients had more intestinal obstruction. These findings emphasize the need for earlier intervention and improved access to advanced therapies in diverse populations.