S1045 Racial Disparities in Utilization of Medications in Inflammatory Bowel Disease Patients

Abstract

Introduction: Inflammatory bowel disease (IBD) is traditionally associated with European ancestry but is increasingly seen among the different races and ethnicities in the United States. Large, multicenter studies across the US and Canada report more complex disease phenotypes among African American individuals. In our study, we explored the disparities in the treatment of IBD among the major racial groups in the United States. Methods: We used a multi-institutional database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), we identified all patients (age >18 years) with a diagnosis of IBD (either Crohn’s disease (CD) or Ulcerative colitis (UC) between 1999 to present. Based on race, the study population was divided into two groups African American and Caucasian. The two groups were further categorized based on the type of medical therapy for IBD, such as thiopurines, methotrexate, 5-ASA, anti- tumor necrosis factor (anti-TNF), ustekinumab, and vedolizumab. Results: Of the 70,383,890 individuals in the database, we identified 249,420 (0.35%) patients with CD and 208,990 (0.30%) patients with UC. Among all IBD patients, 32,870 were African American (8 %) and 314,660 (76.2 %) were Caucasian. When compared with Caucasians, African American IBD patients were less likely to be treated with immunomodulator therapy such as 5-ASA [OR 0.86, p < 0.0001], methotrexate [OR 0.82, p < 0.0001] and thiopurines [OR 0.85, p < 0.0001] and immunosuppressant therapy with biologics such as anti-TNF [0.91, p < 0.0001], Ustekinumab [OR 0.78, p < 0.0001], Vedolizumab [OR 0.74, p < 0.0001] and Tofacitinib [OR 0.61, p =0.0044]. Conclusion: Our large cohort of IBD patients demonstrates significant healthcare disparity in the United States population. African American patients with IBD were significantly less likely to be treated with either immunomodulator or biologic therapy when compared to Caucasians. It is important for gastroenterologists to identify barriers to care in the African American IBD population and implement measures that can improve access to healthcare.Figure 1.: Forest plot of immunomodulators and biologic Therapy in race based-IBD patients. Univariate analysis used to calculated OR. The odds ratio in African Americans are based on whites as reference group. OR; odds ratio. CI; confidence interval. AA; African-American, TNFs; anti tumor necrosis factors, Thiopurines; azathioprine and mercaptopurine, MTX; Methotrexate. Table 1. - Univariate Logistic Regression of immunomodulators and biologic Therapy in race based-IBD patients AA IBD n=31,010 (%) Caucasian IBD n=259,320 (%) OR CI P-value Anti-TNFs 1,560 (5%) 18,460 (7.1%) 0.69 0.65-0.72 < 0.0001 Thiopurine 1,420 (4.5%) 17,090 (6.5%) 0.68 0.64-0.71 < 0.0001 Vedolizumab 300 (0.9%) 4,400 (1.6%) 0.56 0.50-0.63 < 0.0001 Ustekinumab 120 (0.3%) 1,640 (0.6%) 0.61 0.50-0.73 < 0.0001 Tofacitinib 30 (0.1%) 490 (0.2%) 0.51 0.35-0.74 = 0.0004 Methotrexate 620 (1.9%) 6,690 (2.5%) 0.777 0.70-0.83 < 0.0001 5-ASA 8,520 (26%) 90,830 (29%) 0.86 0.84-0.88 < 0.0001 OR; odds ratio. CI; confidence interval. AA; African-American, anti-TNFs; anti tumor necrosis factors, IBD; inflammatory bowel disease. 5-ASA; Mesalamine.