New Research Underscores Racial and Ethnic Disparities in Inflammatory Bowel Disease (IBD) Outcomes

Historically, marginalized groups across the U.S. experience higher rates of health inequities when compared to their white counterparts, including the highest burden of chronic diseases, a lack of access to care, and lower rates of health insurance coverage. [1][2][3] Though inflammatory bowel disease (IBD) has been more prominent in white populations than in communities of color, there has been a steady increase in both its incidence and prevalence across the globe and in varying racial and ethnic groups. [4][5] In the U.S. from 1970 – 2010, the incidence of IBD among people of color increased by 134 percent compared with 39 percent among white people. [5]

While reasons for rising IBD incidence rates and disparities among communities of color remain unknown, new findings give us greater insight into the disparities in disease outcomes and health-related quality of life (HRQoL). [5][6][7] These health inequities inspire Janssen in our commitment to research and better understand disparities in IBD, and we are pleased to be presenting new data at this year’s annual American College of Gastroenterology (ACG) meeting.

Worse IBD Outcomes for People of Color

In an anonymous online survey from a large health system in the U.S., patients of color living with IBD reported worse clinical disease, such as inadequate control of IBD symptoms and more abdominal pain and diarrhea, than their white and non-Hispanic counterparts. [6] These patients were also more likely to be underinsured and likely to report more difficulties in seeing an IBD specialist than white and non-Hispanic patients. Electronic medical record data, which had been stripped of direct identifiers to examine healthcare resource utilization, suggest racially and ethnically diverse patients also utilized more emergency department services. [6]

In a separate study, researchers reported interim analyses of data from the National Health and Wellness Survey (2018 – 2020) among adults self-reporting a physician diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC) – the two most common forms of IBD. [7][8] Analyses of the data revealed increased disease severity was associated with greater healthcare resource use among all study participants with UC and in Black and white patients, but not Hispanic patients, with CD. [7]

Negative Impact on Health-related Quality of Life and Employment

In the anonymous online survey, people of color reported lower HRQoL scores than their white and non-Hispanic counterparts and their IBD symptoms were also more likely to impact their employment and financial stability. [6]

The National Health and Wellness Survey analyses also showed increased disease severity was associated with worse HRQoL and work productivity in all patients with UC and in Black and white patients with CD. [7]

Greater Socioeconomic Disadvantages for People of Color

Black patients with moderately to severely active CD had fewer social and financial resources than those with milder clinical disease. This patient population includes a higher proportion of single, uninsured, and low-income households, but these factors did not consistently differ by disease severity in white or Hispanic participants with CD. [7] Healthcare costs were also disproportionate among patients with IBD and white study participants with moderately to severely active UC had significantly lower mean annualized direct medical costs than Black and Hispanic participants ($56,002, $93,298, and $106,693, respectively). [7] People of color also reported additional challenges finding adequate social and emotional support to cope with IBD than their white counterparts. [6]

Acknowledging and Dismantling Barriers of Care

These study findings clearly point to a need to better understand and address the differences in IBD outcomes and the barriers to care experienced by patients from racially and ethnically diverse populations. The increasing rate of IBD among multiple races and ethnicities further underscores the urgency with which we must address inequities in care.

Along with Johnson & Johnson, Janssen is committed to addressing healthcare disparities through a $100 million investment in health equity solutions over the next five years, and we’re working to close the racial health equity gap by increasing diversity in clinical trials for IBD. We’re supporting and partnering with the Color of Crohn’s and Chronic Illness (COCCI), which is the first and only organization that focuses on Black and Brown patients with digestive diseases. Together, our aim is to educate underserved communities about IBD and to raise awareness about clinical research.

One of the most effective ways of understanding and improving health outcomes for all is by having a workforce that appreciates and reflects the diversity of the world around us. I invite you to learn more about careers in immunology at Janssen by visiting us at: https://bit.ly/3hQ8Q24.

#ACG2022 #CrohnsDisease #IBD #Gastroenterology #Immunology #MyCompany

To learn more about our presence at this year’s ACG meeting, please visit: https://bit.ly/3RFltMn.

References

1. Baah FO, Teitelman AM, Riegel B. Marginalization: Conceptualizing patient vulnerabilities in the framework of social determinants of health-An integrative review. Nurs Inq. 2019 Jan;26(1):e12268. http://doi.org/10.1111/nin.12268.
2. Hill L, Artiga S, Sweta H. Key Facts on Health and Health Care by Race and Ethnicity. Kaiser Family Foundation. Jan. 26, 2022. Available at: https://www.kff.org/report-section/key-facts-on-health-and-health-care-by-race-and-ethnicity-health-coverage-and-access-to-and-use-of-care/. Accessed September 2022.
3. Centers for Disease Control. Office of Minority Health & Health Equity. What is Health Equity? Page last reviewed: July 1, 2022. Available at: https://www.cdc.gov/healthequity/whatis/index.html. Accessed September 2022.
4. Cohen NA, Silfen A, Rubin DT. Inclusion of Under-represented Racial and Ethnic Minorities in Randomized Clinical Trials for Inflammatory Bowel Disease. Gastroenterology. 2022 Jan;162(1):17-21. https://doi.org/10.1053/j.gastro.2021.09.035.  
5. Aniwan S, Harmsen WS, Tremaine WJ, Loftus EV Jr. Incidence of inflammatory bowel disease by race and ethnicity in a population-based inception cohort from 1970 through 2010. Therap Adv Gastroenterol. 2019 Feb 6;12:1756284819827692. https://doi.org/10.1177/1756284819827692.
6. Shah SB, et al. Barriers to Inflammatory Bowel Disease (IBD) Care in a Racially and Ethnically Diverse Population: Patient Survey and Chart Review Study. Presented at ACG 2022, Oct. 21-26, 2022.
7. Burbage SC, et al. Association Between Disease Severity, Socioeconomic Factors, Patient-reported Outcomes, and Healthcare Resource Use Across Racial/Ethnic Groups in Inflammatory Bowel Disease: Results from the National Health and Wellness Survey. Presented at ACG 2022, Oct. 21-26, 2022,
8. Crohn's & Colitis Foundation. What is IBD? Available at: https://www.crohnscolitisfoundation.org/what-is-ibd. Accessed September 2022.