Hussain Fatima S, Potlach Tomas, Chi Xiaofei, Gurka Matthew J, Hall Jaclyn, Setya Aniruddh, Chaudhry Naueen A, Pham Angela, Damas Oriana M, Kerman David, Abreu Maria T, Zimmermann Ellen M
Department of Pediatrics, University of Miami, Miami, FL, USA.
College of Medicine, University of Florida, Gainesville, FL, USA.
Inflamm Bowel Dis. 2025 Feb 10;31(2):344-350. doi: 10.1093/ibd/izae219.
Biases in healthcare pose challenges for inflammatory bowel disease (IBD) patients from underrepresented races and ethnicities. Our study aimed to assess the quality of and access to care among underrepresented racial and ethnic populations using a diverse database.
We used the OneFlorida Data Trust, representing over half of Florida's population. We performed a retrospective study from 2012 to 2020. Advanced IBD therapies included a prescription of at least 1 biologic agent or tofacitinib. Disease activity markers included C-reactive protein (CRP), hemoglobin (Hgb), albumin, and white blood cell (WBC). Regression analyses compared the rates of medication use, healthcare utilization, and disease severity by race and ethnicity. Geographic distribution of advanced IBD therapy was analyzed at the county level.
Our study included 10 578 patients. Hispanic patients utilized more biologics than non-Hispanic White (NHW) patients (odds ratio [OR]: 1.3, P < .0001). Non-Hispanic Black patients utilized more steroids than NHW (OR: 1.2, P = .0004). Hispanics had fewer visits to emergency departments (EDs) and fewer admissions compared with NHW (OR: 0.7 and 0.6, respectively; P < .0001). Non-Hispanic Black patients visited ED more frequently than NHW patients (OR: 1.3, P < .0001). Hispanics had lower disease activity markers than NHW based on CRP (OR: 0.5, P = .005), Hgb (OR: 0.4, P < .0001), albumin (OR: 0.7, P < .0001), and WBC (OR: 0.5, P < .0001). Geographic distribution of advanced IBD therapy showed clustered areas in southern and northern Florida.
Our data show an improved access to care pattern in Hispanic patients. However, disparities still exist, and this is evident in the healthcare utilization trends observed among non-Hispanic Black patients.
医疗保健中的偏见给来自代表性不足种族和族裔的炎症性肠病（IBD）患者带来了挑战。我们的研究旨在使用一个多样化的数据库评估代表性不足的种族和族裔人群的医疗质量和医疗可及性。
我们使用了代表佛罗里达州一半以上人口的“OneFlorida数据信托”。我们进行了一项2012年至2020年的回顾性研究。晚期IBD治疗包括至少开具1种生物制剂或托法替布的处方。疾病活动标志物包括C反应蛋白（CRP）、血红蛋白（Hgb）、白蛋白和白细胞（WBC）。回归分析比较了不同种族和族裔的药物使用、医疗利用和疾病严重程度的比率。在县一级分析了晚期IBD治疗的地理分布。
我们的研究纳入了10578名患者。西班牙裔患者使用生物制剂的次数多于非西班牙裔白人（NHW）患者（优势比[OR]：1.3，P <.0001）。非西班牙裔黑人患者使用类固醇的次数多于NHW患者（OR：1.2，P =.0004）。与NHW患者相比，西班牙裔患者去急诊科就诊的次数和住院次数更少（OR分别为0.7和0.6；P <.0001）。非西班牙裔黑人患者去急诊科就诊的频率高于NHW患者（OR：1.3，P <.0001）。基于CRP（OR：0.5，P =.005）、Hgb（OR：0.4，P <.0001）、白蛋白（OR：0.7，P <.0001）和WBC（OR：0.5，P <.0001），西班牙裔患者的疾病活动标志物低于NHW患者。晚期IBD治疗的地理分布显示在佛罗里达州南部和北部有聚集区域。
我们的数据显示西班牙裔患者的医疗可及性模式有所改善。然而，差异仍然存在，这在非西班牙裔黑人患者的医疗利用趋势中很明显。
