Racial/Ethnic Differences in Inflammatory Bowel Disease Medical Treatment and Medication Compliance at a Tertiary Care Academic Medical Center

Abstract

Purpose: Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis (UC), is increasingly recognized in minority patients. Prior studies suggest that African-American (AA) and Hispanic patients with IBD tend to have worse outcomes compared to non-Hispanic white patients. We aimed to compare the racial/ethnic differences in medical treatment and medication compliance among AA, Hispanic, and non-Hispanic white IBD patients at a tertiary care academic medical center. Methods: 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 January, 2011 and October, 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 type (Crohn's disease or UC), medical treatment (5-aminosalicylic acids, steroids, immunomodulators, or biologics), and medication compliance. The chi-square test or Fisher's exact test was used in statistical analysis. Results: There were a total of 535 IBD patients in our study sample, including 87 AAs (49 Crohn's; 38 UC), 44 Hispanics (25 Crohn's; 19 UC), and 404 non-Hispanic whites (182 Crohn's; 222 UC). There was no difference in IBD medical treatment between minority and non-Hispanic white patients (5-aminosalicylic acids: AA 68%, Hispanic 77%, white 71%; steroids: AA 22%, Hispanic 25%, white 17%; immunomodulators: AA 24%, Hispanic 20%, white 19%; Biologics: AA 26%, Hispanic 23%, white 22%; all p>0.10). This pattern remained mostly similar in subgroup analysis of Crohn's disease or UC, except for more steroid use among Hispanic UC patients (AA 8%, Hispanic 32%, white 12%, p<0.05). Compliance with IBD medications was lower among minority patients compared to non-Hispanic white patients (AA 83%, Hispanic 83%, white 93%; p<0.01). Conclusion: At our tertiary care academic medical center, medical treatment of IBD was similar between minority and non-Hispanic white patients, but medication compliance was lower among minorities. The latter might contribute to racial/ethnic differences in IBD outcomes.