DELAYED ONSET OF TREATMENT IN A PATIENT WITH ULCERATIVE COLITIS: A CASE OF HOW DISPARITIES AFFECT HEALTHCARE ACCESS

Abstract

Abstract INTRODUCTION Most of the literature available on Inflammatory Bowel Disease (IBD) comes from studies performed in white population. Recent studies indicate a potential shift in the epidemiology of IBD in the United States, with significantly greater increases in incidence rates noted in non-White patients. (1) However, the burden of this disease on black and non-black Hispanic is unknown. This prompts a re-examination of the challenges these populations face including access to care issues and financial barriers. (2) Patients and health outcomes are impacted by multiple social and community factors often referred to as Social Determinants of Health (SDOH). SDOH are defined as “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”(1) The concept of social determinants of health contributing to poor healthcare outcomes in certain populations comes from the recognition that race and economic factors are linked to awareness of disease and access to care. In this abstract, we describe a case that exhibits the mechanism in which social determinants of health lead to a poor health outcome. CASE DESCRIPTION An 18-year-old female college student from Hispanic background who presented with diarrhea associated with weight loss for 6 months, seen by a local gastroenterologist who performed a colonoscopy that depicted patchy inflammatory changes throughout the colon with microscopic evidence of ulcerative colitis for which she was prescribed Infliximab, however, she was unable to afford the medication due to the high out-of-pocket cost and she did not receive and alternative medication nor follow up from her physician. For the next few months, the patient was not receiving treatment which resulted in a course of protracted diarrhea and gastrointestinal bleed with hypovolemic shock and ICU admission. At that time, abdominopelvic CT scan demonstrated inflammatory changes of the transverse and left colon. During admission she was started on the aforementioned drug and on discharge she was again prescribed Infliximab, however this time our patient started working as part time and was able to obtain the medication through her private insurance. Since the onset of treatment she has improved, her bowel frequency went from about 20 bowel movements daily to 4-5. She is still having minimal rectal bleeding, but the volume of blood has decreased considerably. DISCUSSION This case illustrates one of the many examples of how health disparities impact disease course. Although recently literature that discusses health disparities in IBD patients is increasing, it is essential to focus on social determinants of health as the cause of inequities in patient care in order to improve disease outcome on these underrepresented populations.