Mo1095 Racial/Ethnic Differences in Inflammatory Bowel Disease Risk Factors Medication Compliance and Outcomes At a Tertiary Care Academic Medical Center

Abstract

Background: Inflammatory bowel disease (IBD) including Crohn's disease and ulcerative colitis (UC) is increasingly recognized in minority patients. Prior studies suggest that African American and Hispanic patients with IBD tend to have worse outcomes compared to nonHispanic white patients. Aims: To compare the racial/ethnic differences in risk factors for IBD flare, medication compliance, and symptom-free remission among African American, Hispanic and non-Hispanic white IBD patients at a tertiary care academic medical center. Data andMethods: A list of all inpatient and outpatient visits with attending gastroenterologists and an ICD-9 diagnosis code for IBD (Crohn's disease 555.x; UC 556.x) between 01/2011 and 10/2012 were provided by the Health Information Management Department. Chart review was performed to verify IBD diagnosis and to obtain patient demographics including race/ ethnicity, IBD phenotype (Montreal classification for Crohn's; extent of UC), risk factors (primary sclerosing cholangitis, family history of IBD, smoking, previous bowel surgery, use of steroids, narcotics, or non-steroidal anti-inflammatory drugs), compliance with IBD medications, and presence of symptom-free remission. Both medication compliance and remission were based on assessment of the attending gastroenterologist at the most recent visit. The chi-square test or Fisher's exact test and the multivariate logistic model were used in statistical analysis. Results: There were a total of 502 IBD patients in our study sample, including 86 African Americans (47 Crohn's; 39 UC), 43 Hispanics (23 Crohn's; 20 UC), and 373 non-Hispanic whites (154 Crohn's; 219 UC). Compared with non-Hispanic whites, narcotic use was higher among minorities (African Americans 15.3%, Hispanics 20.9%, Whites 8.4%; both p,0.05). Racial/ethnic differences in the other risk factors were insignificant. Compared with non-Hispanic whites, both medication compliance (African Americans 81.9%, Hispanics 82.9%, Whites 91.7%) and symptom-free remission (African Americans 10.5%, Hispanics 20.9%, Whites 27.1%) were lower among minorities (both p ,0.05). In multivariate logistic regression, African American (odds ratio [OR]: 0.323, 95% confidence interval [CI]: 0.142-0.735 vs. non-Hispanic white) and family history of IBD (OR: 0.409, 95% CI: 0.168-0.994) were negative predictors of symptom-free remission (both p,0.05). Conclusions: More narcotic use and lower medication compliance among minorities might contribute to racial/ethnic differences in IBD outcomes. African American race and family history of IBD were associated with a lower likelihood of remission. Whether some of the racial/ethnic differences in IBD outcomes can be explained by differences in socioeconomic status, risk factors for disease flare and medication compliance is an important question for future research.