Racial Disparities and Effect on Quality of Care Among Hospitalized Patients With Inflammatory Bowel Disease: Findings From the National Health Discharge Survey

Abstract

Introduction: Racial and ethnic disparities play a major role in the quality of healthcare delivery and outcomes in chronic diseases including Inflammatory Bowel Disease (IBD). Studies have shown that compared with other racial groups, whites have a higher prevalence and incidence of IBD while blacks experience significantly higher IBD-related hospitalizations and deaths relative to their prevalence. However, the role of race on the quality of care in IBD is unclear. Using length of hospital Stay (LOS), a validated surrogate measure of healthcare quality and efficiency, we sought to determine the impact of ethnicity on quality of care among hospitalized patients with IBD. Methods: We sampled 120 patients aged 18-90 years who had a primary admitting diagnosis of IBD (ulcerative colitis and Crohn's disease). LOS was modeled as a binary variable (< median LOS, ≥ median LOS). Multivariable logistic and linear regression was used to estimate the median LOS and odds ratio (OR) of increased duration of hospital stay by race/ethnicity, adjusted for health insurance status, age and sex. Results: Of the 120 sampled patients (mean age = 42 ± 14 years; 58% female; 81% white; 13% blacks) with admitting diagnosis of IBD, the median length of stay for the entire sample was 5 days across all racial groups. There was no significant difference in the median LOS when we compared the three racial categories, Whites (median 5 days; IQR: 6, 3) vs Blacks (median 5 days; IQR: 6, 3) vs others (median 5.5 days; IQR: 7, 4). The odds ratio for a median LOS of 5 days or more when adjusted for age and sex was higher in Blacks (OR 1.30, 95% CI: 0.43, 3.91) compared to whites, though this was not statistically significant. Similarly, the OR for a median LOS of 5 days or more when adjusted for age and sex was higher in other race/ethnic groups (OR 1.59 CI: 0.27, 9.31) compared with whites. Conclusion: To our knowledge, no study has examined the impact of race/ethnicity on LOS in hospitalized patients with IBD. In contrast to other outcome measures like mortality, racial disparity does not appear to have an effect on duration of hospital stay in IBD. We believe that the disproportionately high IBD related-mortality seen in blacks is not likely due to the quality of care during hospital admission as measured by the LOS. More studies should explore biologic and environmental factors which may likely impact disparities in IBD severity and mortality outcomes.