IBD is “increasingly seen among the different races and ethnicities in the United States,” noted the researchers, led by Khaled Alsabbagh Alchirazi, MD, a clinical assistant professor at the Cleveland Clinic Lerner College of Medicine. In addition, “large, multicenter studies across the U.S. and Canada report more complex disease phenotypes among [Black] individuals,” which underscores the need to increase efforts to optimize care for diverse IBD populations.
Dr. Alsabbagh and his co-investigators, including senior investigator Miguel Regueiro, MD, the Chair of Cleveland Clinic’s Digestive Disease & Surgery Institute, used the Explorys multi-institution electronic health record database to identify adults diagnosed with Crohn’s disease or ulcerative colitis between 1999 and 2022 across 26 major U.S. health systems. They stratified the cohort by race to compare likelihood of treatment with various medical therapies in Black and white patients. Dr. Alsabbagh told Gastroenterology & Endoscopy News that, to his knowledge, the study is the largest U.S.-based study assessing “racial disparities in IBD medications.”
Of the approximately 70 million people in the Explorys database, they identified 458,419 (0.65%) patients with IBD, 54.4% with Crohn’s disease (249,429) and 45.6% with ulcerative colitis (208,990). Approximately 8% of the patients were Black and approximately 76% were white.
The odds of treatment with various immunomodulator and biologic therapies, including anti-TNF agents, ustekinumab (Stelara, Janssen), vedolizumab (Entyvio, Takeda) and tofacitinib (Xeljanz, Pfizer), was lower in Black patients than in white patients (Table), the investigators reported at the 2022 annual meeting of the American College of Gastroenterology (abstract A0370).
The consequences of underutilization of advanced therapies can be significant, including “worse outcomes and development of such complications as fistula and strictures,” which can “lead to more emergency department visits, hospitalizations and surgeries,” Dr. Alsabbagh said.
| Table. Odds of Treatment for Black Versus White Patients | ||
| Agent | Odds ratio | 95% CI |
|---|---|---|
| Tofacitinib | 0.51 | 0.35-0.74 |
| Vedolizumab | 0.56 | 0.50-0.63 |
| Ustekinumab | 0.61 | 0.50-0.73 |
| Thiopurines | 0.68 | 0.64-0.71 |
| Anti-TNF | 0.69 | 0.65-0.72 |
| Methotrexate | 0.78 | 0.70-0.83 |
| 5-ASA | 0.86 | 0.84-0.88 |
| 5-ASA, 5-aminosalicylic acid; anti-TNF, anti–tumor necrosis factor. Based on the 2022 annual meeting of the American College of Gastroenterology (abstract A0370). | ||
Understanding and Addressing the Disparity
Aline Charabaty, MD, an assistant professor of medicine at Johns Hopkins School of Medicine and the clinical director of the IBD Center at Johns Hopkins-Sibley Memorial Hospital, in Washington, D.C., who was not involved in the study, noted that although the investigators did not provide information about the disease severity and activity and the use of specific therapies, most of the available data show that Black patients have disease severity and phenotypic presentations that are similar to those of white patients. Thus, she said, “we have to think there are more serious reasons why [Black patients] receive effective therapies less often.” Specifically, she told Gastroenterology & Endoscopy News, “a significant proportion of Blacks have limited access to medical and specialty care and continuity of care because of socioeconomic and geographical factors, racial bias and other social determinants of health that lead to health disparities and inequities in IBD.”
Concluding with a call to action, the research team emphasized the need “for gastroenterologists to identify barriers to care in the [Black] IBD population and implement measures that can improve access to healthcare.”
Dr. Charabaty agreed, saying “as a healthcare system and society, we need to find ways to make IBD care accessible and affordable to everyone affected with this disease.”
She recommended strategies that could be implemented to reduce health disparities in IBD. “It is essential to raise awareness with our colleagues—gastroenterologists, primary care providers, emergency and acute care physicians—that IBD can affect Black and brown populations.” In addition, she said, “it is important to reach out to Black and brown communities where they are, to provide education on IBD and on the effective therapies available.” She stressed that promoting efforts to increase patient health literacy and agency, including “supporting patient education and grassroots patient advocacy efforts,” such as Colors of Crohn’s and Chronic Illness and South Asian IBD Alliance, is “crucial.”
—Natasha Albaneze
Dr. Alsabbagh reported no relevant financial disclosures. Dr. Charabaty reported financial relationships with AbbVie, Bristol Myers Squibb, Janssen, Pfizer and Takeda. Dr. Charabaty is a member of the Gastroenterology & Endoscopy News editorial board.
For more from Dr. Regueiro on the team’s research on IBD disparities, visit gastroendonews.com/Multimedia.
This article is from the January 2023 print issue.