P0559 - A Tale of Two IBD Centers: Disparities in Health Utilization and Outcomes in IBD Patients by Race, Employment, and Insurance Status at a Private and Public Hospital in New York City

Samantha Zullow, MD¹, Barathi Sivasailam, MD², Jonathan Galati, MD¹, Takahiro I. Nakamura, MD¹, Jordan Axelrad, MD, MPH^1
1New York University School of Medicine, New York, NY; ²New York University Langone Medical Center, New York, NY

Introduction: Health disparities in health care utilization and clinical outcomes are strongly linked to race, ethnicity, socioeconomic, and insurance status in many diseases. We aimed to measure racial and socioeconomic disparities in inflammatory bowel disease (IBD) care including disease characteristics, treatment, health care utilization, and clinical outcomes.

Methods: We performed a retrospective chart review of patients 18 years and older with established IBD care at a private or public hospital in New York City. Established care was defined as having at least 1 colonoscopy and 1 clinic visit within the same hospital. Patient demographics, disease characteristics, and outcomes were collected. Multivariate logistic regression was performed and reported as odds ratios (OR) with 95% confidence intervals (CI).

Results: A total of 322 patients, 50% from each hospital, were included in the analysis. Public hospital IBD patients were more likely to have Medicaid and visit the ED (17% vs 6%, OR 5.3, CI 2.1-14, and 41% vs. 11%, OR 4.0, 1.5-11,) compared to private hospital patients. Focusing on race, Black IBD patients were more likely to be hospitalized (36%, OR 7.6 CI 1.0-161) compared to other races. In terms of insurance, Medicare patients were more likely to be hospitalized and require surgery (28%, OR 4.9 CI 1.1 – 22 and 16%, OR 14, CI 1.7-120) compared to uninsured patients or those with Medicaid or private insurance. Unemployed IBD patients had higher rates of surgery (18% vs. 9%, OR 3.6, CI 1.2 – 10). CD patients who were unemployed had higher rates of prolonged steroid use, ED visits, and hospitalizations (OR 8.5, CI 1.2 – 79, OR 14, CI 1.7 – 173, OR 15, 1.9 – 191) compared to employed CD patients. UC patients with Medicaid were more likely to be hospitalized (OR 3.6, 1.0 – 14) compared to uninsured patients or those with Medicaid or private insurance. UC patients with private insurance were more likely to achieve mucosal healing (OR 5.3, 1.1 – 31) compared to uninsured patients or those with Medicaid or Medicare.

Discussion: Race, employment, and insurance status were linked with disparities in IBD care. Public hospital use, Black race, unemployment, and non-private insurance were associated with various adverse IBD outcomes including increased ED visits, hospitalizations, requirement for surgery, prolonged steroid use, and decreased rates of mucosal healing. Future work should focus on identifying interventions to resolve disparities for these patient populations.

	Prolonged Steroid Use n (%), OR (CI)	ED visits n (%), OR (CI)	Hospitalizations n (%), OR (CI)	Surgery n (%), OR (CI)
Female	47 (26.9%), 0.69 (0.36-1.27)	42 (24%), 1.35 (0.71 - 2.58)	38 (21.7%), 1.45 (0.77 - 2.76)	17 (9.7%), 1.09 (0.42 - 2.82)
Male	40 (27.4%), 1 (ref)	40 (27.4%), 1 (ref)	41 (28.1%), 1 (ref)	16 (11.0%), 1 (ref)
Employed	65 (25.3%) 1 (ref)	61 (23.7%), 1 (ref)	61 (23.7%), 1 (ref)	23 (8.9%), 1 (ref)
Unemployed	21 (36.8%), 1.66 (0.77-3.54)	20 (35.1%), 1.66 (0.74 - 3.71)	17 (29.8%), 0.93 (0.40 - 2.05)	10 (17.5%), 3.56 (1.23 - 10.30)
Unknown (race)	3 (30.0%), 1 (ref)	3 (30%), 1(ref)	1 (10.0%), 1 (ref)	0 (0%), NA
White	38 (27.1%), 0.89 (0.17 - 5.25)	19 (13.6%), 0.88 (0.18 - 5.25)	28 (20.0%), 2.77 (0.39 - 56.88)	17 (12.1%), NA
Black	16 (36.4%), 1.53 (0.28 - 9.77)	18 (40.9%), 3.22 (0.62 - 19.80)	16 (36.4%), 7.62 (1.03 - 160.90)	6 (13.6%), NA
Asian	9 (27.3%), 1.39 (0.22 - 10.10)	7 (21.2%), 1.35 (0.20 - 10.04)	6 (18.2%), 3.05 (0.31 - 72.06)	4 (12.1%), NA
Other	10 (22.2%), 1 (0.18 - 6.54)	20 (44.4%), 3.13 (0.60 - 19.30)	17 (37.8%), 8.27 (1.11 - 176.77)	5 (11.1%), NA
Hispanic	11 (25.6%), 1.45 (0.23 - 10.28)	15 (34.9%), 3.26 (0.56 - 22.52)	11 (25.6%), 6.11 (0.72 - 137.39)	1 (2.3%), NA
Uninsured	16 (22.5%), 1 (ref)	24 (33.8%), 1 (ref)	19 (26.8%), 1 (ref)	6 (8.5%), 1 (ref)
Medicaid	20 (28.2%) 0.99 (0.38-2.53)	30 (42.3%), 1.54 (0.67 - 3.55)	24 (33.8%), 1.87 (0.76 - 4.67)	6 (8.5%), 0.97 (0.22 - 4.22)
Medicare	11 (44.0%), 10.56 (2.52.- 48.6)	5 (20.0%), 1.70 (0.36 - 7.46)	7 (28.0%), 4.92 (1.13 - 21.69)	4 (16.0%), 13.84 (1.68 - 120.35)
Private Insurance	40 (27.0%), 1.28 (0.48 - 3.4)	22 (14.9%), 1.12 (0.44 - 2.83)	29 (19.6%), 1.76 (0.67 -4.71)	17 (11.5%), 2.25 (0.53 - 10.19)
Private Hospital	46 (28.6%), 1 (ref)	17 (10.6%), 1 (ref)	29 (18.0%), 1 (ref)	17 (10.6%), 1 (ref)
Public Hospital	41 (25.6%), 1.17 (0.44 - 3.11)	50 (31.2%), 4.04 (1.53 - 10.95)	50 (31.2%), 1.57(0.58 - 4.25)	16 (10.0%), 1.72 (0.39 - 7.14)

Table: Clinical Outcomes for Inflammatory Bowel Disease Patients by Gender, Employment Status, Race/Ethnicity, Insurance Status, and Public or Private Hospital


Disclosures:
Samantha Zullow indicated no relevant financial relationships.
Barathi Sivasailam indicated no relevant financial relationships.
Jonathan Galati indicated no relevant financial relationships.
Takahiro Nakamura indicated no relevant financial relationships.
Jordan Axelrad: Abbvie – Advisory Committee/Board Member. BioFire Diagnostics – Consultant, Grant/Research Support. Janssen – Consultant.


Samantha Zullow, MD¹, Barathi Sivasailam, MD², Jonathan Galati, MD¹, Takahiro I. Nakamura, MD¹, Jordan Axelrad, MD, MPH¹. P0559 - A Tale of Two IBD Centers: Disparities in Health Utilization and Outcomes in IBD Patients by Race, Employment, and Insurance Status at a Private and Public Hospital in New York City, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.