Racial Disparities Impact Crohn's Disease Treatment

Medication adherence, hospital readmissions, and surgical complications have significant differences related to race.

Factors related to the treatment of Crohn’s Disease are affected by the race of the patient, a recent study found.

The study, published in the IBD Journal, noted significant disparities in hospital readmissions, medication adherence, and medical and surgical complications in children with Crohn's disease related to race. The researchers found that African American children had a hospital readmission frequency 1.5 times higher than Caucasian children.

"We found racial inequalities exist among children and adolescents with Crohn's disease, likely due to a combination of genetic and environmental differences," principal investigator Jennifer Dotson, MD, MPH, said in a press release. "This is one of the first studies to investigate the rate of various health disparities in the Crohn's disease population in pediatrics, despite the fact that 25 percent of the time, Crohn's disease is diagnosed in childhood."

The study included data from the Pediatric Health Information System database to evaluate racial disparities in the treatment and outcomes for Caucasian and African American patients suffering from moderate to severe Crohn's disease. Included were more than 4000 patients age 21 and under who were admitted to a hospital due to the disease between 2004 and 2012.

The data revealed that African American children had a shorter time to their first readmission to the hospital.

"A physician or other clinical staff may not readily identify these racial differences at a single-practice level, but these gaps may be important on a larger scale," Dr. Dotson said. "Further studies need to help identify the causes of these racial differences so we can design interventions for hospitals and physician offices that can reduce population level disparities. Clinicians at Nationwide Children's involved in the study are keeping this in mind and continuing to collect data."

The researchers are planning to evaluate outpatient factors that may play a role in the disparities, including follow-up frequency. They are also investigating racial and socioeconomic disparities related to the treatment and outcomes of young Crohn's disease patients.

African American children were also more likely to have anemia, vitamin D deficiency, endoscopic procedures, blood product transfusions, and receive treatment with steroids and biologic agents compared with Caucasian pediatric Crohn's disease patients. The race of the patients was not found, however, to influence bowel surgery risk.

"Some of the differences in our study are likely attributable to intrinsic differences in disease between blacks and whites," Dr. Dotson said. "For example, more procedures are likely a result of the increased rate of perianal disease in blacks. Other differences may reflect disparities in care, although biologic differences can't be excluded."

The rising use of corticosteroids and biologic drugs in African American patients may indicate a more severe disease course potentially as a result of a worse intrinsic disease in these children, the study noted. This may also be attributed to children who were more ill when they were admitted due to delays or difficulties in accessing care, which subsequently required more intensive therapy, according to the study.

Additionally, African American children were found to come households with a lower median income and were more likely to have Medicaid.

"Financial barriers to outpatient care and self-management, such as transportation, medication and nutrition needs, may have impacted the outcome for these children,” Dr. Dotson concluded.