Racial disparities in utilization of medications and disease outcomes in inflammatory bowel disease patients

Authors

Khaled Alsabbagh Alchirazi, Advocate Health - MidwestFollow
Osama Hamid, Department of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Thabet Qapaja, Department of Hospital Medicine, Washington University in St. Louis, St. Louis, MO, USA.
Mohammad Aldiabat, Department of Hospital Medicine, Washington University in St. Louis, St. Louis, MO, USA.
Nour Azzouz, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA.
Motasem Alkhayyat, Department of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, USA.
Miguel Regueiro, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA.

Recommended Citation

Alsabbagh Alchirazi K, Hamid O, Qapaja T, et al. Racial Disparities in Utilization of Medications and Disease Outcomes in Inflammatory Bowel Disease Patients. Crohns Colitis 360. 2025;7(2):otaf021. Published 2025 Mar 16. doi:10.1093/crocol/otaf021

Abstract

Background:Although traditionally associated with White European ancestry, inflammatory bowel disease (IBD) has increased among different races and ethnicities. Large studies conducted in the United States and Canada have identified more complex disease phenotypes among Black patients. Our study aimed to investigate disparities in IBD treatments and outcomes between Black and White patients in the United States.

Methods:Using the TriNetX database, adult IBD patients were divided into 2 groups based on race: Black and White patients with IBD, Crohn's disease (CD), or ulcerative colitis (UC). Medical therapy and disease outcomes were evaluated in both groups with 1:1 propensity-score matching. Methodologic limitations include the potential for missing data, lack of information on socioeconomic strata, and patient-level medication coverage plans.

Results:In comparison to White patients, Black patients with CD were less likely to receive advanced therapies; Adalimumab (adjusted odds ratio- aOR 0.89), Certolizumab (0.81), Vedolizumab (0.66), Ustekinumab (0.82), or Tofacitinib (0.58). Black patients with UC were less likely to receive advanced therapies; Adalimumab (0.83), Golimumab (0.62), Vedolizumab (0.69), Ustekinumab (0.73), or Tofacitinib (0.55). Black patients with IBD were at higher odds of utilizing corticosteroids (CD 1.18 and UC 1.20) and opioids (CD 1.26 and UC 1.09). Black patients with CD had higher rates of hospitalization (1.35) and perianal abscess (1.56), perianal fistula (1.28), and intestinal fistula (1.38). Black patients with UC had higher rates of hospitalization (1.29), Clostridioides difficile infection (1.11), and toxic megacolon (1.34).

Conclusions:There were racial disparities in IBD medical therapy and disease outcomes. Black IBD patients had lower treatment with advanced therapies, higher opioid and corticosteroid use, and higher IBD-related complications.

Type

Article

PubMed ID

40260307