Hawkins Rachel L, Zia Maryam, Hind Daniel, Lobo Alan J
Sheffield Centre for Health and Related Research, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom.
Sheffield Inflammatory Bowel Disease Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Sheffield, United Kingdom.
Inflamm Bowel Dis. 2024 Dec 5;30(12):2486-2499. doi: 10.1093/ibd/izae077.
Inflammatory bowel diseases (IBDs) are incurable diseases that require lifelong access to health services. Accumulating evidence of inequalities in health care access, experience, and outcomes for individuals with IBD is apparent. This review aimed to describe the inequalities in healthcare access, experiences, and outcomes of care for adults with IBD, to identify research gaps, and to identify future research priorities in this area.
A scoping review was conducted to retrieve quantitative, qualitative, and mixed methods evidence from 3 databases (EMBASE, Medline, and CINAHL) published between January 1, 2000, and September 27, 2023.
Fifty-one studies met the criteria for inclusion. The majority (42 of 51) focused on IBD health outcomes, followed by healthcare access (24 of 51). Significantly fewer investigated patient experiences of IBD healthcare (8 of 51). Most available studies reported on race/ethnic disparities of healthcare (33 of 51), followed by inequalities driven by socioeconomic differences (12 of 51), rurality (7 of 51), gender and sex (3 of 51), age (2 of 51), culture (2 of 51), literacy (1 of 51), and sexuality (1 of 51). Inflammatory bowel disease patients from Black, Asian, and Hispanic ethnic groups had significantly poorer health outcomes. A lack of research was found in the sexual and gender minority community (1 of 51). No research was found to investigate inequalities in IBD patients with learning disabilities or autism.
Further research, particularly utilizing qualitative methods, is needed to understand health experiences of underserved patient populations with IBD. Cultural humility in IBD care is required to better serve individuals with IBD of Black and Asian race/ethnicity. The lack of research amongst sexual and gender minority groups with IBD, and with learning disabilities, poses a risk of creating inequalities within inequalities.
炎症性肠病（IBD）是无法治愈的疾病，需要终身获得医疗服务。越来越多的证据表明，IBD患者在医疗服务可及性、就医体验和治疗结果方面存在不平等现象。本综述旨在描述成年IBD患者在医疗服务可及性、就医体验和治疗结果方面的不平等现象，识别研究空白，并确定该领域未来的研究重点。
进行了一项范围综述，以检索2000年1月1日至2023年9月27日期间在3个数据库（EMBASE、Medline和CINAHL）中发表的定量、定性和混合方法的证据。
51项研究符合纳入标准。大多数研究（51项中的42项）关注IBD的健康结果，其次是医疗服务可及性（51项中的24项）。调查IBD患者医疗体验的研究明显较少（51项中的8项）。大多数现有研究报告了医疗服务中的种族/民族差异（51项中的33项），其次是社会经济差异导致的不平等（51项中的12项）、农村地区（51项中的7项）、性别（51项中的3项）、年龄（51项中的2项）、文化（51项中的2项）、读写能力（51项中的1项）和性取向（51项中的1项）。来自黑人、亚洲人和西班牙裔种族群体的IBD患者健康结果明显较差。在性取向和性别少数群体中发现的研究较少（51项中的1项）。未发现有研究调查IBD合并学习障碍或自闭症患者的不平等现象。
需要进一步开展研究，尤其是采用定性方法，以了解IBD患者中未得到充分服务的人群的健康体验。IBD护理中需要具备文化谦逊态度，以更好地服务黑人和亚洲种族/民族的IBD患者。IBD性取向和性别少数群体以及合并学习障碍群体缺乏研究，这有可能在不平等现象中造成新的不平等。
