S1051 Differences in Healthcare Resource Utilization and Costs by Race/Ethnicity in Patients With Inflammatory Bowel Disease: Results From the National Health and Wellness Survey

Abstract

Introduction: Across many chronic diseases, racial and ethnic disparities are evident in healthcare resource utilization (HCRU). Inflammatory bowel disease (IBD) is associated with significant morbidity, particularly with sub optimal care, and rates of inpatient care may act as a surrogate for disease severity. The objective of this study was to characterize the relationship of race/ethnicity and with HCRU and costs in patients with IBD. Methods: Adults with a self-reported physician diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC) who participated in the United States National Health and Wellness Survey (2018-2020) were included. Bivariate (interim) analyses were conducted to compare HCRU and costs across racial/ethnic groups. Results: Analyses included 2,577 participants (CD: 818 White, 109 Black, and 150 Hispanic; UC: 1,150 White, 99 Black, and 251 Hispanic). Hispanic participants reported more mean emergency room (ER) visits (CD: 1.92 [SD 5.63]; UC: 1.93 [4.20]) and hospitalizations (CD: 1.98 [4.44]; UC: 1.76 [5.63]) over six months than White participants (CD: 0.96 [2.18] and 0.75 [1.99], P=0.001 and P< 0.001, respectively; UC: 0.66 [2.56] and 0.60 [3.22], both P< 0.001). Hispanic participants with CD also had more mean hospitalizations than Black participants (1.98 [4.44] vs. 1.02 [2.00], P< 0.006), and Black participants with UC had more ER visits than White participants (1.44 [2.39] vs. 0.66 [2.56], P=0.03). Higher annualized direct medical costs were found for Hispanic (CD: $92,636 [$169,447]; UC: $94,919 [$214,961]) than for White participants with CD and UC (CD: $53,681 [$90,905]; UC: $45,721 [$147,649], both P< 0.001) and Black participants with CD ($56,803 [$80,328], P=0.02). Total annual costs due to work productivity impairment were higher for Hispanic participants than for White participants with CD ($20,852 [$19,775] vs. $15,961 [$17,847], P = 0.03), but were not significantly different for any other comparisons. (Table) Conclusion: Black and Hispanic participants with IBD had higher HCRU and direct medical costs than White participants. Notably, Hispanic participants with CD also had higher HCRU and direct medical costs than Black participants, highlighting the need to consider different racial/ethnic groups separately when assessing health outcomes and burden of disease. Further research is needed to better characterize the relationship between race/ethnicity and HCRU, including consideration of disease severity as a factor. Table 1. - HCRU and medical costs in White, Black, and Hispanic participants with IBD CD (N = 1,077) UC (N = 1,500) White (n = 818) Black (n = 109) Hispanic (n = 150) White (n = 1,150) Black (n = 199) Hispanic (n = 251) Gender, n (%)MaleFemale 397 (48.5%)421 (51.5%) 54 (49.5%)55 (50.5%) 95 (63.3%)† 55 (36.7%)† 454 (39.5%)696 (60.5%) 52 (52.5%)*47 (47.5%)* 113 (45.0)138 (55.0%) Age in years, mean (SD) 48.34 (16.48) 36.84 (14.39)* 34.05 (11.05)† 52.48 (16.28) 38.48 (16.08) 38.45 (14.27)† HCRU (past 6 months), mean (SD)Total number of HCP visitsa Total number of GE visitsTotal number of ER visitsTotal number of hospitalizations 7.24 (9.87)0.76 (1.18)0.96 (2.18)0.75 (1.99) 6.02 (6.93)0.87 (1.65)1.45 (3.27)1.02 (2.00) 7.33 (8.61)0.43 (1.05)†,‡ 1.92 (5.63)† 1.98 (4.44)†,‡ 6.11 (6.70)0.54 (1.00)0.66 (2.56)0.60 (3.22) 7.32 (8.98)0.41 (0.83)1.44 (2.39)*1.40 (2.32) 10.55 (31.50)† 1.10 (4.68)†,‡ 1.93 (4.20)† 1.76 (5.63)† Costs (USD), mean (SD)Total annualized direct medical costs Total annual costs due to workproductivity impairmentb $53,681 ($90,905)$15,961 ($17,847) $56,803 ($80,328)$14,963 ($16,977) $92,636($169,448)†,‡ $20,852 ($19,775)† $45,721 ($147,649)$14,344 ($18,673) $74,117 ($90,924)$12,652 ($16,339) $94,919 ($214,961)† $17,240 ($16,399) a Includes visits to any of the following: general practitioner/family practitioner; internist; allergist; cardiologist; dentist; dermatologist; diabetologist; endocrinologist; gastroenterologist; geriatrician; gynecologist; hepatologist; infectious disease specialist/infectologist (diseases such as HIV or hepatitis); neurologist; nephrologist; nurse practitioner/physician assistant; obstetrician; oncologist; ophthalmologist; orthopedist; otolaryngologist (ears, nose, and throat specialist); plastic surgeon; podiatrist; psychiatrist; psychologist/therapist; pulmonologist (lung specialist); respiratory therapist; rheumatologist; urologist; other medical specialist. b Total annual costs due to work productivity impairment were only calculated among respondents who were participating in the labor force at the time of the survey and who had a valid response (i.e., non-missing) for the number of hours working in the past 7 days and the number of hours missed in the past 7 days. * P < 0.05 between Black/African American and White participants. † P < 0.05 between Hispanic and White participants. ‡ P < 0.05 between Hispanic and Black/African American participants. Note: P values were calculated using Bonferroni-adjusted pairwise comparisons. Abbreviations: BMI = body mass index; CD = Crohn’s Disease; ER = emergency room; GE = gastroenterologist; HCP = healthcare provider; HCRU = healthcare resource utilization; IBD = inflammatory bowel disease; UC = ulcerative colitis, USD = United States dollar.