Division of Colon and Rectal Surgery, Medical University of South Carolina, Charleston, SC, USA.
Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA.
Inflamm Bowel Dis. 2022 Sep 1;28(9):1405-1419. doi: 10.1093/ibd/izab237.
Existing evidence for disparities in inflammatory bowel disease is fragmented and heterogenous. Underlying mechanisms for differences in outcomes based on race and socioeconomic status remain undefined. We performed a systematic review of the literature to examine disparities in surgery for inflammatory bowel disease in the United States.
Electronic databases were searched from 2000 through June 11, 2021, to identify studies addressing disparities in surgical treatment for adults with inflammatory bowel disease. Eligible English-language publications comparing the use or outcomes of surgery by racial/ethnic, socioeconomic, geographic, and/or institutional factors were included. Studies were grouped according to whether outcomes of surgery were reported or surgery itself was the relevant end point (utilization). Quality was assessed using the Newcastle-Ottawa Scale for observational studies.
Forty-five studies were included. Twenty-four reported surgical outcomes and 21addressed utilization. Race/ethnicity was considered in 96% of studies, socioeconomic status in 44%, geographic factors in 27%, and hospital/surgeon factors in 22%. Although study populations and end points were heterogeneous, Black and Hispanic patients were less likely to undergo abdominal surgery when hospitalized; they were more likely to have a complication when they did have surgery. Differences based on race were correlated with socioeconomic factors but frequently remained significant after adjustments for insurance and baseline health.
Surgical disparities based on sociologic and structural factors reflect unidentified differences in multidisciplinary disease management. A broad, multidimensional approach to disparities research with more granular and diverse data sources is needed to improve health care quality and equity for inflammatory bowel disease.
现有炎症性肠病（IBD）差异的证据零碎且不统一。基于种族和社会经济地位的结果差异的潜在机制仍未确定。我们对文献进行了系统回顾，以检查美国炎症性肠病手术差异。
从 2000 年至 2021 年 6 月 11 日，通过电子数据库搜索，以确定解决成年人炎症性肠病手术治疗差异的研究。纳入比较手术使用或结果的合格英语出版物，比较种族/族裔、社会经济、地理和/或机构因素的手术。根据报告手术结果或手术本身是相关终点（利用），将研究分为两组。使用纽卡斯尔-渥太华量表对观察性研究进行质量评估。
共纳入 45 项研究。24 项报告了手术结果，21 项解决了利用问题。96%的研究考虑了种族/民族，44%的研究考虑了社会经济地位，27%的研究考虑了地理因素，22%的研究考虑了医院/外科医生因素。尽管研究人群和终点各不相同，但住院的黑人和西班牙裔患者进行腹部手术的可能性较小；当他们确实接受手术时，他们更有可能出现并发症。基于种族的差异与社会经济因素相关，但在调整保险和基线健康状况后，这些差异仍然显著。
基于社会和结构因素的手术差异反映了多学科疾病管理中未识别的差异。需要采用广泛的、多维度的方法来研究差异，并使用更细致和多样化的数据来源，以提高炎症性肠病的医疗质量和公平性。
