S132 Disparity of Care Is Not Observed Across Racial and Ethnic Groups During Hospitalization for Inflammatory Bowel Disease

Abstract

Background: Although Inflammatory Bowel Disease (IBD) is more common in non-Hispanic White populations, rates are increasing among non-Whites. Despite some possible differences in disease phenotypes between racial groups, disease management guidelines are identical for different groups. However, multiple studies have demonstrated that social determinants of health (SDOH) play a critical role in disease management and outcomes for patients with IBD, as patients from minority populations often have delayed diagnosis, increased surgeries, and post-surgical complications. Several factors likely contribute to these healthcare disparities, with financial compensation and access to healthcare among them. Hospital admission ideally provides a setting that removes these barriers, and therefore should not be associated with healthcare disparities, though this has not been previously studied. We sought to identify if SDOH guide inpatient management of patients with IBD. Methods: We conducted a retrospective cohort study of adult patients with IBD-related inpatient admissions to any of Northwell Health’s 21 hospitals between 2010-2018. Patients were identified by a hospital admission primary diagnosis of ulcerative colitis (UC) or Crohns disease (CD), or a secondary diagnosis of UC or CD with a primary diagnosis of diarrhea, abdominal pain, or gastrointestinal bleeding. We analyzed data on patient demographics, medical history, and inpatient management features, including the use of imaging, medications, and procedures. Biological medication was defined as the use of infliximab, adalimumab, certolizumab. Race/ethnicity was characterized as Hispanic, Asian, Black, White, other, and unknown. Insurance status was characterized as private, Medicare, or Medicaid. Self-pay patients were excluded from analysis. Variables were tested using logistic regression for binary outcomes. To control the overall Type 1 error rate for the hypothesis that there were racial disparities in inpatient management of IBD, the Holm-Bonferroni method was used to adjust the P-value thresholds for statistical significance in each of the multiple tests performed to evaluate the hypothesis. Results: In total, 1,732 patients were identified and included in the analysis. Overall, 57% (n = 985) were White, 9% Hispanic, 5% Asian, 13% Black, 6% other, 9% unknown. 55% of patients were female, 45% had Crohn’s Disease, 14% were on steroids prior to admission. 47% of patients had private insurance, with the remaining having either Medicare or Medicaid. When assessing hospital interventions and outcomes based on racial/ethnic group, there was no difference in length of stay, use of medications (corticosteroids, aminosalicylic acid formulations, opioids, biological) during hospital admission and on discharge, stool testing performed as inpatient, imaging (CT, MRI) or endoscopies performed. Conclusion(s): SDOH play a critical role in the disease course and outcomes for patients with IBD. In this large retrospective study, we found that among patients hospitalized for IBD exacerbations there was no disparity of care across racial/ethnic groups. Our findings suggest that factors such as insurance status and access to healthcare are likely the main contributors to the healthcare disparities seen in the outpatient setting. Our results reflect the experience in a large urban health care system, and further studies are needed to replicate the data in other settings.