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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
Volume49
Issue5
Pagination564-571
Date Published2019 03
ISSN1365-2036
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
Abstract

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.

DOI10.1111/apt.15107
Alternate JournalAliment Pharmacol Ther
PubMed ID30663075
Grant ListUL1 TR002384 / TR / NCATS NIH HHS / United States
/ / Crohn's and Colitis Foundation / International