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Disparities in child height at the time of inflammatory bowel disease diagnosis
Joann M Samalik1, Grace J Lee1, Zubin J Modi2,3
1Division of Pediatric Gastroenterology, C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Insights
Children diagnosed with inflammatory bowel disease (IBD) without private insurance or of Hispanic/Latino ethnicity are more likely to experience growth delay. This highlights disparities in IBD diagnosis and care.
Area of Science:
- Pediatric gastroenterology
- Public health
- Health equity
Background:
- Growth delay is a known indicator of severe pediatric inflammatory bowel disease (IBD) at diagnosis.
- However, variations in height at diagnosis and their correlation with socioeconomic factors remain under-explored.
Purpose of the Study:
- To investigate the association between socioeconomic status, specifically insurance status and ethnicity, and the presence of growth delay at diagnosis in pediatric IBD patients.
- To identify potential disparities in IBD diagnosis and care.
Main Methods:
- Retrospective analysis of prospectively collected data from pediatric patients (<18 years) diagnosed with IBD within 90 days.
- Growth delay defined as height Z-score <-1.
- Insurance status was categorized as private or non-private.
Main Results:
- A total of 13,691 patients were analyzed. Patients without private insurance showed a 20% higher likelihood of growth delay (24.2%) compared to those with private insurance (20.1%).
- Hispanic/Latino children had a higher prevalence of growth delay (25.7%) than non-Hispanic/Latino children (20.7%).
- The highest proportion of growth delay was observed in Hispanic/Latino children without private insurance (28.6%).
Conclusions:
- Hispanic/Latino children and those lacking private insurance face a greater risk of growth delay at IBD diagnosis.
- Factors such as diagnostic delays and food insecurity likely contribute to these disparities.
- Ensuring equitable access to timely diagnosis and care is crucial for all pediatric IBD patients, irrespective of their life circumstances.
Objectives:
Growth delay is associated with severe disease at inflammatory bowel disease (IBD) diagnosis. Variation in height at diagnosis is unknown. We hypothesize that growth delay at diagnosis is more common among individuals of low socioeconomic status.
Methods:
We retrospectively evaluated prospectively collected data from patients <18 year and enrolled in the ImproveCareNow (ICN) Network <90 days after IBD diagnosis. The primary outcome was growth delay at enrollment, defined as height Z-score <-1. Insurance was dichotomized as presence or absence of private insurance.
Results:
Among 13,691 patients included, 6015 were female (44%), median age 13.6 year (interquartile range 11.0-15.8), 1583 (11.6%) Black, 9951 (72.7%) White, 935 (6.8%) other race, 723 (5.3%) Hispanic/Latino and 10,154 (74.2%) non-Hispanic/Latino ethnicity, and 9425 (68.8%) with, and 3011 (22.0%) without private insurance. Patients without private insurance were 20% more likely to have growth delay (N = 728, 24.2%) than those with private insurance (N = 1894, 20.1%; p < 0.001). Among Hispanic/Latino patients, 25.7% (N = 186) had growth delay, compared to 20.7% (N = 2,098) non-Hispanic/Latino (p = 0.001). Hispanic/Latino patients without private insurance had the greatest proportion with growth delay (N = 107, 28.6%) compared to all others (N = 2762, 20.7%; p < 0.001).
Conclusions:
Hispanic/Latino children and those without private insurance are more likely to have growth delay at IBD diagnosis. Diagnostic delay and food insecurity are likely contributors. Medical care should be equitable despite life circumstance. This study identifies opportunities to improve care by emphasizing the importance of timely diagnosis. Improving access is necessary at each phase of care to ensure equitable timely diagnosis for all patients.
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