Segura Abraham, Brensinger Colleen, Pate Virginia, Siddique Shazia M, Parlett Lauren, Hurtado-Lorenzo Andres, Kappelman Michael David, Lewis James D
Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Center of Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Am J Gastroenterol. 2025 Apr 1. doi: 10.14309/ajg.0000000000003438.
Advances in medical and surgical therapy have improved the outlook for those affected with Crohn's disease and ulcerative colitis; however, it is unclear whether Americans from marginalized racial and ethnic backgrounds have adequate and equitable access to care for inflammatory bowel disease (IBD). We evaluated the association between race and ethnicity and healthcare utilization in patients diagnosed with inflammatory bowel disease.
This study identified children and adults diagnosed with IBD in 2 national data sets from 2016 to 2017. We modeled the association between healthcare utilization and racial and ethnic subpopulations across different age groups using generalized estimating equations adjusted by disease and socioeconomic factors.
Among working-age adults, Black Americans had higher emergency department admission, hospitalization, and steroid use than White patients; however, these differences were attenuated after adjusting for socioeconomic factors. Asian and Hispanic Americans were less likely to receive outpatient gastroenterological care and medical therapy even after adjustment. Emergency department use was more likely among elderly Black patients. Hispanic children had increased healthcare utilization for IBD compared with White children, although these results did not meet statistical significance.
Healthcare utilization for long-term management of IBD is lower in historically marginalized racial and ethnic groups compared with White Americans. Further research is needed to identify and address modifiable patient, clinician, and healthcare system barriers to achieve health equity in the management of IBD.
医学和外科治疗的进展改善了克罗恩病和溃疡性结肠炎患者的预后；然而，尚不清楚来自边缘化种族和族裔背景的美国人是否能充分且公平地获得炎症性肠病（IBD）的治疗。我们评估了种族和族裔与炎症性肠病患者医疗保健利用之间的关联。
本研究在2016年至2017年的2个国家数据集中识别出被诊断为IBD的儿童和成人。我们使用经疾病和社会经济因素调整的广义估计方程，对不同年龄组中医疗保健利用与种族和族裔亚人群之间的关联进行建模。
在工作年龄的成年人中，非裔美国人的急诊科就诊、住院和类固醇使用情况高于白人患者；然而，在调整社会经济因素后，这些差异有所减弱。即使在调整后，亚裔和西班牙裔美国人接受门诊胃肠病护理和药物治疗的可能性也较小。老年非裔患者更有可能使用急诊科。与白人儿童相比，西班牙裔儿童因IBD的医疗保健利用有所增加，尽管这些结果未达到统计学显著性。
与美国白人相比，历史上被边缘化的种族和族裔群体对IBD长期管理的医疗保健利用较低。需要进一步研究以识别和解决可改变的患者、临床医生和医疗保健系统障碍，以在IBD管理中实现健康公平。
