Understanding the Impact of Perceived Stigma on Healthcare Perception and Medication Utilization Among Black...

Inflammatory bowel diseases (IBD) remain understudied in Black populations despite studies suggesting a disproportionate rising incidence and worse health outcomes for this demographic when compared to White populations in the United States. Perceived stigma impacts outcomes in other chronic disease states but is poorly studied in IBD. Thus, we aimed to assess the impact of perceived stigma in Black participants with IBD.

A web-based questionnaire was administered from July through August 2022 in partnership with the Color of Gastrointestinal Illnesses. Poisson regression was used to estimate relative risks (RR) and 95% confidence intervals (CIs) for the association between perceived stigma and primary outcomes of medication nonadherence, perception of care, anxiety, and depression. All models were multivariate adjusted and restricted to Black respondents.

This study included 1142 Black participants with IBD. The majority of respondents were male (57.9%), held a diagnosis of ulcerative colitis (58.9%), were from the South (33.7%), completed high school as their highest level of education (31.2%), and endorsed moderate stigma levels (57.4%). Perceived stigma was associated with medication nonadherence (moderate stigma: RR 0.95 [0.91-0.99]; low stigma 0.79 [0.70-0.89]). While moderate stigma had higher RR for poor perception of care (1.14; 1.10-1.19), low stigma had lower RR (0.88; 0.82-0.94). Mood outcomes were not significantly associated with perceived stigma.

Perceived stigma significantly impacted healthcare perception and utilization for Black participants with IBD. Future studies are needed for better understanding of the interplay between perceived stigma and IBD health outcomes.