Disability in inflammatory bowel disease patients is associated with race, ethnicity and socio-economic factors.

TitleDisability in inflammatory bowel disease patients is associated with race, ethnicity and socio-economic factors.
Publication TypeJournal Article
Year of Publication2019
AuthorsAgrawal M, Cohen-Mekelburg S, Kayal M, Axelrad J, Galati J, Tricomi B, Kamal K, Faye AS, Abrudescu P, Scherl E, Lawlor G, Sultan K, Lukin D, Colombel J-F, Ungaro RC
JournalAliment Pharmacol Ther
Date Published2019 03
KeywordsAdult, Continental Population Groups, Cross-Sectional Studies, Disabled Persons, Ethnic Groups, Female, Humans, Inflammatory Bowel Diseases, Male, Middle Aged, New York City, Prospective Studies, Socioeconomic Factors, Young Adult

BACKGROUND: Race, ethnicity and socio-economic status impact clinical outcomes in inflammatory bowel disease (IBD) patients. However, their impact on disability has not been studied.

AIM: To determine the association between race, ethnicity and socio-economic factors with disability in IBD, using the validated IBD disability index (IBD-DI).

METHODS: Ambulatory IBD patients were enrolled at five academic centres participating in the New York Crohn's and Colitis Organization. We assessed the IBD-DI, and collected clinical and socio-economic data. Factors associated with moderate-to-severe disability (IBD-DI score > 35) on univariable analysis were tested in multivariable models with adjusted odds ratios (aOR) and 95% confidence intervals (CI) reported.

RESULTS: In this study, 323 patients (57.3% CD, 51.4% female) were enrolled; 17.7% were Hispanic, 17% were non-Hispanic black, 56.0% were non-Hispanic Caucasian and 9.3% belonged to non-Hispanic non-black minority races. However, 39.0% of patients were publicly insured and 38.4% of patients had low annual household income (<$50 000). 100 (31.0%) patients reported moderate-to-severe disability. On multivariable analysis, Hispanic ethnicity (aOR 2.7, 95% CI 1.3-5.6), non-Hispanic non-black minority race (aOR 3.5, 95% CI 1.3-8.9), public payer (aOR 2.1, 95% CI 1.1-4.0) and low annual household income (aOR 3.0, 95% CI 1.7-5.4) were associated with moderate-to-severe disability controlling for disease characteristics.

CONCLUSIONS: IBD patients who are minorities, have public insurance, or low household income, are 2-3 times more likely to report moderate-to-severe disability independent of disease characteristics in the United States. Future studies are needed to study their complex relationship and to mitigate disability.

Alternate JournalAliment Pharmacol Ther
PubMed ID30663075
Grant ListUL1 TR002384 / TR / NCATS NIH HHS / United States
/ / Crohn's and Colitis Foundation / International