Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Inflamm Bowel Dis. 2021 Feb 16;27(3):364-370. doi: 10.1093/ibd/izaa090.
Prior studies have identified racial disparities in the treatment and outcomes of inflammatory bowel disease (IBD). These disparities could be secondary to differences in biology, care delivery, or access to appropriate therapy. The primary aim of this study was to compare medication use among Medicaid-insured black and white patients with IBD, given uniform access to gastroenterologists and therapies.
We analyzed Medicaid Analytic eXtract data from 4 states (California, Georgia, North Carolina, and Texas) between 2006 and 2011. We compared the use of IBD-specific therapies, including analyses of postoperative therapy among patients with Crohn disease (CD). We performed bivariate analyses and multivariable logistic regression, adjusting for potential confounders.
We identified 14,735 patients with IBD (4672 black [32%], 8277 with CD [58%]). In multivariable analysis, there was no significant difference in the odds of anti-tumor necrosis factor use by race for CD (adjusted odds ratio [aOR] = 1.13; 95% confidence interval [CI], 0.99-1.28] or ulcerative colitis (aOR = 1.12; 95% CI, 0.96-1.32). Black patients with CD were more likely than white patients to receive combination therapy (aOR = 1.50; 95% CI, 1.15-1.96), and black patients were more likely than white patients to receive immunomodulator monotherapy after surgery for CD (31% vs 18%; P = 0.004).
In patients with Medicaid insurance, where access to IBD-specific therapy should be similar for all individuals, there was no significant disparity by race in the utilization of IBD-specific therapies. Disparities in IBD treatment discussed in prior literature seem to be driven by socioeconomic or other issues affecting access to care.
先前的研究已经确定了炎症性肠病（IBD）在治疗和结局方面存在种族差异。这些差异可能是由于生物学、护理提供或获得适当治疗的差异造成的。本研究的主要目的是比较医疗保险覆盖的黑人和白人 IBD 患者的药物使用情况，因为他们都可以获得胃肠病学家和治疗方法。
我们分析了 2006 年至 2011 年间来自加利福尼亚州、佐治亚州、北卡罗来纳州和得克萨斯州的 4 个州的医疗补助分析提取数据。我们比较了 IBD 特异性治疗的使用情况，包括克罗恩病（CD）患者术后治疗的分析。我们进行了双变量分析和多变量逻辑回归，调整了潜在的混杂因素。
我们确定了 14735 名 IBD 患者（4672 名黑人[32%]，8277 名 CD[58%]）。在多变量分析中，CD（调整后的优势比[aOR] = 1.13；95%置信区间[CI]，0.99-1.28]）或溃疡性结肠炎（aOR = 1.12；95%CI，0.96-1.32）患者中，种族对抗肿瘤坏死因子的使用几率没有显著差异。与白人患者相比，黑人 CD 患者更有可能接受联合治疗（aOR = 1.50；95%CI，1.15-1.96），黑人患者比白人患者更有可能在 CD 手术后接受免疫调节剂单药治疗（31% vs 18%；P = 0.004）。
在医疗保险覆盖的患者中，所有个体获得 IBD 特异性治疗的机会应该相似，但种族之间在使用 IBD 特异性治疗方面没有显著差异。先前文献中讨论的 IBD 治疗差异似乎是由影响获得护理的社会经济或其他问题驱动的。
