Lack of Discrepancy in Inflammatory Bowel Disease Hospitalization Outcomes Among Patients of Different Race or Ethnicity

Abstract

Introduction: Race is known to affect the quality and delivery of care for multiple disease states. The incidence of inflammatory bowel disease (IBD) is rising among racial minorities, and healthcare disparities are becoming increasingly obvious. We therefore sought to identify the effect of race or ethnicity on IBD hospitalization outcomes. Methods: Inpatient discharge data from a database covering more than 90% of nonprofit academic hospitals in the US and their affiliated community centers (the Vizient clinical database) was used to answer this question. Hospital discharge data from 10/1/2015 to 3/31/2018 was critically analyzed. Hospital discharges were identified by a principal ICD-10 diagnosis of ulcerative colitis (UC) or Crohn's disease (CD). Patients who were transferred to another hospital were excluded. Unadjusted outcomes between racial (White, Black, or Asian) or ethnic (Hispanic) groups were compared using the one-way ANOVA and Pearson chi-squared test. Using multivariate linear regression of aggregated hospital discharge data, we examined the effect of race or ethnicity on mean length of stay (LOS), mean direct cost, and 30-day readmissions while adjusting for potential confounders. Results: We identified a total of 19,063 hospitalizations for UC and 37,838 hospitalizations for CD among 323 medical centers (152 academic, 184 community). Unadjusted hospitalization outcomes by race or ethnicity are presented in table 1. For UC, black patients had a shorter mean LOS (5.68 days, p<0.01) compared to other racial or ethnic groups. For CD, Hispanic patients had a lower mean direct cost ($6,415, p<0.01) and black patients had a higher 30-day readmission rate (12.0%, p<0.01) compared to other racial or ethnic groups. After multivariate linear regression to control for confounders, the only significant association was lower mean direct cost for black and white patients in UC (table 2) and CD (table 3) hospitalizations. Conclusion: Racial and ethnic disparities were seen only for unadjusted outcomes among hospitalized IBD patients. When controlling for other demographics, hospital factors, disease severity, comorbidities, and payer status, these effects were not appreciated. This suggests that there is no observable difference for mean LOS, mean direct hospitalization cost, and readmission rate that is attributable to race or ethnic background. Future prospective evaluation is appropriate to validate these findings.643_A Figure 1. *P-values for compared means and frequencies were calculated using one-way ANOVA and chi-squared tests, respectively. LOS = length of stay, SD = standard deviation.643_B Figure 2. LOS = length of stay, CMI = case mix index, OSH = outside hospital, SOI = severity of illness, ICU = intensive care unit. *Reference point for White, Black, and Asian race and for Hispanic ethnicity was “Other or unreported.”643_C Figure 3. LOS = length of stay, CMI = case mix index, OSH = outside hospital, SOI = severity of illness, ICU = intensive care unit. *Reference point for White, Black, and Asian race and for Hispanic ethnicity was “Other or unreported.”