“Our study found significant disparities in how different racial and ethnic groups access and use healthcare services for inflammatory bowel disease in the U.S.,” says the study coauthor Andrés Hurtado-Lorenzo, PhD, a senior vice president of translational research and IBD ventures at the Crohn’s & Colitis Foundation.
Importantly, many of the inequities observed in the study shrank significantly after adjustments were made for household income and dual Medicare-Medicaid eligibility, which suggests socioeconomic barriers and structural racism may play a major role, says Dr. Hurtado-Lorenzo.
Older Black Adults Were 50 Percent More Likely to Seek IBD Treatment in the ER
Researchers used data on more than three million people from two national datasets covering 2016 to 2017 to look at how Asian, Black, Hispanic, and white Americans of different ages with IBD accessed healthcare and medicines.
Key findings included:
- Working-age Asian and Hispanic Americans are less likely to receive regular gastroenterological care or use prescribed medications to manage their condition than white Americans.
- Black Americans aged 65 and older are nearly 50 percent more likely to go to the ER than white people.
- Hispanic children use healthcare services more frequently than white children, though this result did not reach statistical significance. They were more likely to undergo diagnostic tests, such as endoscopy and imaging, and receive treatments like steroids. But they were no more likely to receive advanced therapies than their white peers.
Investigators also found disparities in access to advanced IBD therapies, such as biologics and JAK inhibitors, across different racial and ethnic groups. But the gaps decreased significantly after researchers adjusted for household income and dual Medicare-Medicaid eligibility.
“That implies household income and access to comprehensive insurance coverage play a key role in determining who can receive these advanced, and often costly, IBD treatments,” says Hurtado-Lorenzo.
Further analysis showed significantly lower use of advanced therapies among Asian children and older Black adults with more advanced IBD than among their white counterparts, says Hurtado-Lorenzo. “This suggests that racial minorities with more severe, treatment-refractory IBD may face additional barriers in accessing the most effective, guideline-recommended medications,” he says.
The findings should be used to shape new policies and future research priorities to improve health disparities in IBD care, said Dr. Segura.
People of Color Are Diagnosed With IBD at More Than 3 Times the Rate of White Americans
What Doctors Can Do to Address the Inequities
Healthcare providers can support patients of color by addressing their own implicit biases, working to help patients navigate equitable access to treatments, and using culturally sensitive communication, says Hurtado-Lorenzo.
“Providers should also consider social determinants of health — such as transportation challenges or language barriers — when developing care plans,” he says.
People of Color May Need to Be Proactive to Overcome Barriers in Care
“To better care for their condition, patients of color can take proactive steps such as seeking out IBD specialists and asking about all available treatment options, including advanced therapies like biologics,” says Hurtado-Lorenzo. Don’t hesitate to ask questions about your treatment and advocate for regular follow-ups with a gastroenterologist, he adds.
Additionally, you can work with your healthcare provider to develop a comprehensive care plan to reduce the likelihood you’ll have to go to the ER for emergency care.
You can also enroll in a clinical trial to help researchers learn more about IBD disease processes, symptoms, and treatment response in people of color. ClinicalTrials.org has a search function, or you can ask your provider about trials in your area.
