RACIAL AND ETHNIC DISPARITIES IN INFLAMMATORY BOWEL DISEASE SURGERY AND IN-HOSPITAL UTILIZATION METRICS IN THE UNITED STATES
Kush M. Fansiwala*1, Ellen Spartz1, Lauren C. DeDecker1, Shaya Noorian1, Andrew R. Roney1, Elizabeth Dente1, Joanna Turkiewicz2, Christopher Soriano1, Alejandro Sarabia Gonzalez1, Jamie O. Yang1, Siotame Lasitani1, Jenny S. Sauk3, Mary Kwaan1, Berkeley N. Limketkai3
1University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA; 2UCLA Medical Center Olive View, Sylmar, CA; 3Center for Inflammatory Bowel Diseases, Vatche & Tamar Manoukian Division of Digestive Diseases, University of California Los Angeles, Los Angeles, CA
Black and Hispanic patients are known to undergo inflammatory bowel disease (IBD) surgery at lower rates, but the reason for this disparity is unclear. IBD patients who transfer between hospitals undergo surgery at a higher rate at recipient hospitals, suggesting inter-hospital transfers may explain the gap seen in minority groups. In this study, we aim to evaluate racial/ethnic disparities of IBD-related surgeries and transfers for surgeries, as well as utilization metrics of length of stay (LOS) and total charges (TCHG).
The National Inpatient Sample for 2016-2018 was queried using ICD-10 codes to identify patients with ulcerative colitis (UC) and Crohn's disease (CD) who did or did not undergo surgery. Amongst patients who underwent surgery, we collected data on those who underwent inter-hospital transfer for surgery. Univariable and multivariable logistic regression were performed to identify risk factors for surgery, transfers for surgery, LOS, and TCHG. Covariates included age, sex, race, comorbidity index, payer, income quartile, region, hospital bed size, hospital location, and hospital teaching status.
From 2016-2018, 625,575 (62.7%) patients were hospitalized for CD and 372,480 (37.3%) for UC, with 6.6% and 8.3% of patients undergoing surgery in each group, respectively. Differences in patient and hospital characteristics were noted between surgical and non-surgical groups in both the UC and CD populations (Table 1). Amongst those with CD, Black patients (OR 0.90, 95% CI 0.82–0.97) were less likely to undergo surgery. Amongst those transferred for CD surgery, there were no significant differences between racial groups. Amongst those with UC, Black patients were also less likely to undergo surgery (OR 0.70, 95% CI 0.62–0.78), race/ethnicity was not associated with hospital transfer for CD surgery. Income quartile was not related to surgery or transfer, for either CD or UC. Amongst those who underwent surgery, Black patients had increased LOS for both CD (OR 1.16, 95% CI 0.13–2.18) and UC (OR 1.83, 95% CI 0.05–3.60), while Hispanic populations had similar LOS to non-Hispanic patients but increased relative TCHG ($39708, 95% CI 12973–66442).
While Black race was associated with decreased rates of surgery for both CD and UC and increased LOS, and Hispanic ethnicity was associated with increased costs, there were no racial/ethnic differences in hospital transfers. Our findings suggest access to referral centers may contribute less to decreased surgeries seen in Black populations. Income and insurance status are also less likely to contribute, given inclusion as covariates. Other possible explanations for our observations are motivation to activate care or deferral of surgery amongst certain groups. Further research is needed to ascertain additional social or biologic factors contributing to our findings.
Patient and hospital characteristics of hospitalized patients with Crohn's disease and ulcerative colitis
Figure 1 Adjusted odds ratios for race/ethnicity as a predictor of transfer for surgery and surgery in Ulcerative Colitis and Crohn's disease patients
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