Abstract
Racial disparities are observed clinically in Crohn’s Disease (CD) with research suggesting African Americans (AA) have worse outcomes than Caucasian Americans (CA). The aim of this study is to assess whether socioeconomic status (SES) rather than race is the major predictor of worse outcomes. We designed a retrospective cohort study of 944 CD patients seen at our center. Patients’ billing zip codes were collected and average income and percent of population living above or below poverty level (PL) for each zip code calculated. Patients were separated by quartiles using average state income level and federal PL. Demographics and hospitalization rates were collected. Poison regression models estimated incidence rate ratios (IRR) for CD-related hospitalizations. Incidence rate (IR) of hospitalization per 100-person years for the lowest income group was 118 (CI 91.4–152.3), highest income group was 29 (CI 21.7–38.9), Above PL was 26.9 (25.9–28.9), Below PL was 35.9 (33.1–38.9), CA was 25.3 (23.7–27), and AA was 51.4 (46.8–56.3). IRR for a CD-related hospitalization for lowest income group was 2.01 (CI 1.34–3.01), for Below PL was 1.26 (CI 1.12–1.42), and for AAs was 1.88 (CI 1.66–2.12). SES and race are both associated with hospitalization among CD patients and need further investigation.
Highlights
Crohn’s Disease (CD) is a chronic inflammatory disorder affecting approximately 780,000 people in the United States[1]
Last known billing zip codes were collected for each patient and used to obtain US Census data concerning average income and percentage of population living below federal poverty level (FPL) in that zip code
Presence of metabolic syndrome was similar across groups with the exception of Quartile Lower class (QT L) where no patients were found to have metabolic syndrome
Summary
Crohn’s Disease (CD) is a chronic inflammatory disorder affecting approximately 780,000 people in the United States[1]. It was initially believed that this disease predominantly affected Caucasians, and it was not until 1966 that inflammatory bowel disease (IBD) was studied in the African American (AA) population[2,6]. A higher incidence of CD has been observed in the general population as well as in AAs7,8. In numerous diseases, including cardiac disease, obesity, and diabetes mellitus, AAs suffer poorer outcomes, receive fewer therapeutic interventions, and, in some series, have been found to have higher mortality than their CA counterparts. Our study tests the hypothesis that socioeconomic status (SES) is the main predictor of worse outcomes rather than a biological difference related to race
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