645 Black and White Patients With Inflammatory Bowel Disease Demonstrate Similar Biologic Use Patterns With Medicaid Insurance

Abstract

INTRODUCTION: Prior studies have indicated that significant disparities exist when comparing black and white patients with inflammatory bowel disease (IBD), including increased emergency department visits and difficulty accessing specialists for Crohn's disease (CD) and ulcerative colitis (UC). The primary objective of this study was to compare any use of IBD-specific therapies among black and white patients with Medicaid Insurance, where race is self-reported at enrollment and patients have uniform insurance coverage. Among patients with CD who underwent surgery, we also aimed to evaluate postoperative therapies. METHODS: We performed a retrospective cohort study, analyzing data from the Medicaid Analytic Extract from four states (CA, GA, NC, and TX) between 2007 and 2014. We compared the use of IBD-specific therapies between black and white patients with IBD, including specific analyses of postoperative therapy among patients with CD. We performed bivariate analyses and multivariable logistic regression, adjusting for potential confounders. RESULTS: We identified 14,735 patients with IBD [4,672 black race (32%), 8,277 CD (58%)]. Among all 14,375 patients, 64% received at least one IBD-specific medication. Black patients were significantly more likely to receive therapy with an immunomodulator (20% vs. 15%, P < 0.001), an anti-tumor necrosis alpha (anti-TNF) therapy (23% vs. 18%, P < 0.001), combination therapy with an anti-TNF and an immunomodulator (4% vs. 3%, P < 0.001) and prednisone (43% vs. 38%, P < 0.001, Table 1). In multivariable analysis, there was no significant difference in odds of anti-TNF use by race for CD [adjusted Odds Ratio (aOR) 1.13, 95% Confidence Interval (CI): 0.99-1.28] or UC (aOR 1.12, 95% CI: 0.96-1.32, Table 2). Black patients with CD were more likely to receive combination therapy (aOR 1.50, 95% CI: 1.15-1.96). Among 398 patients undergoing surgery for CD, black patients received earlier postoperative therapy with an anti-TNF (median 94 days vs. 132 days, P = 0.023) and azathioprine (median 53 days vs. 92 days, P = 0.024), with no significant difference noted in use of methotrexate in the post-operative period. CONCLUSION: In patients with Medicaid Insurance, where access to IBD-specific therapy should be similar for all individuals, there was no significant disparity by race in the utilization of IBD-specific therapies. Access to comparable insurance benefits may aid significantly in resolving apparent healthcare disparities.