Skip to main content

Advertisement

Log in

Racial and Ethnic Differences in Health Care Utilization and Outcomes Among Ulcerative Colitis Patients in an Integrated Health-Care Organization

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Current knowledge of racial disparities in healthcare utilization and disease outcomes for ulcerative colitis (UC) is limited. We sought to investigate these differences among Caucasian, African American, Asian, and Hispanic patients with ulcerative colitis in Kaiser Permanente, a large integrated health-care system in Northern California.

Methods

This retrospective cohort study used computerized clinical data from 5,196 Caucasians, 387 African–Americans, 550 Asians, and 801 Hispanics with prevalent UC identified between 1996 and 2007. Healthcare utilization and outcomes were compared at one and five-year follow-up by use of multivariate logistic regression analysis.

Results

Compared with whites, the male-to-female ratio differed for African–Americans (0.68 vs. 0.91, p < 0.01) and Asians (1.3 vs. 0.91, p < 0.01). Asians had fewer co-morbid conditions (p < 0.01) than whites, whereas more African–Americans had hypertension and asthma (p < 0.01). Use of immunomodulators did not differ significantly among race and/or ethnic groups. Among Asians, 5-ASA use was highest (p < 0.05) and the incidence of surgery was lowest (p < 0.01). Prolonged steroid exposure was more common among Hispanics (p < 0.05 at 1-year) who also had more UC-related surgery (p < 0.01 at 5-year) and hospitalization (<0.05 at 5-year), although these differences were not significant in multivariate analysis.

Conclusions

In this population of UC patients with good access to care, overall health-care utilization patterns and clinical outcomes were similar across races and ethnicity. Asians may have milder disease than other races whereas Hispanics had a trend toward more aggressive disease, although the differences we observed were modest. These differences may be related to biological factors or different treatment preferences.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

IBD:

Inflammatory bowel disease

UC:

Ulcerative colitis

5-ASA:

5-Aminosalicylate

COPD:

Chronic obstructive pulmonary disease

OR:

Odds ratio

CI:

Confidence interval

References

  1. The chronic care model. In: Improving Chronic Illness Care. http://www.improvingchroniccare.org/index.php?p=The_Chronic_Care_Model&s.

  2. Simsek H, Schuman BM. Inflammatory bowel disease in 64 black patients: analysis of course, complications, and surgery. J Clin Gastroenterol. 1989;11:294–298.

    Article  CAS  PubMed  Google Scholar 

  3. Flasar MH, Johnson T, Roghmann MC, et al. Disparities in the use of immunomodulators and biologics for the treatment of inflammatory bowel disease: a retrospective cohort study. Inflamm Bowel Dis. 2008;14:13–19.

    Article  PubMed  Google Scholar 

  4. Nguyen GC, Torres EA, Regueiro M, et al. Inflammatory bowel disease characteristics among African Americans, Hispanics, and non-Hispanic Whites: characterization of a large North American cohort. Am J Gastroenterol. 2006;101:1012–1023.

    Article  PubMed  Google Scholar 

  5. Thia KT, Loftus EV Jr, Sandborn WJ, et al. An update on the epidemiology of inflammatory bowel disease in Asia. Am J Gastroenterol. 2008;103:3167–3182.

    Article  PubMed  Google Scholar 

  6. Appleyard CB, Hernandez G, Rios-Bedoya CF. Basic epidemiology of inflammatory bowel disease in Puerto Rico. Inflamm Bowel Dis. 2004;10:106–111.

    Article  PubMed  Google Scholar 

  7. Kitahora T, Utsunomiya T, Yokota A. Epidemiological study of ulcerative colitis in Japan: incidence and familial occurrence. The Epidemiology Group of the Research Committee of Inflammatory Bowel Disease in Japan. J Gastroenterol. 1995;30:5–8.

    PubMed  Google Scholar 

  8. Torres EA, De Jesus R, Perez CM, et al. Prevalence of inflammatory bowel disease in an insured population in Puerto Rico during 1996. P R Health Sci J. 2003;22:253–258.

    PubMed  Google Scholar 

  9. Herrinton LJ, Liu L, Lewis JD, et al. Incidence and prevalence of inflammatory bowel disease in a Northern California managed care organization, 1996–2002. Am J Gastroenterol. 2008;103:1998–2006.

    Article  PubMed  Google Scholar 

  10. Hou JK, El-Serag H, Thirumurthi S. Distribution and manifestations of inflammatory bowel disease in Asians, Hispanics, and African Americans: a systematic review. Am J Gastroenterol. 2009;104:2100–2109.

    Article  PubMed  Google Scholar 

  11. Mahid SS, Mulhall AM, Gholson RD, et al. Inflammatory bowel disease and African Americans: a systematic review. Inflamm Bowel Dis. 2008;14:960–967.

    Article  PubMed  Google Scholar 

  12. Jiang L, Xia B, Li J, et al. Retrospective survey of 452 patients with inflammatory bowel disease in Wuhan city, central China. Inflamm Bowel Dis. 2006;12:212–217.

    Article  PubMed  Google Scholar 

  13. Jiang XL, Cui HF. An analysis of 10218 ulcerative colitis cases in China. World J Gastroenterol. 2002;8:158–161.

    PubMed  Google Scholar 

  14. Zheng JJ. Clinical aspects of ulcerative colitis in mainland China. Chin J Dig Dis. 2006;7:71–75.

    Article  PubMed  Google Scholar 

  15. Nguyen GC, Laveist TA, Gearhart S, et al. Racial and geographic variations in colectomy rates among hospitalized ulcerative colitis patients. Clin Gastroenterol Hepatol. 2006;4:1507–1513.

    Article  PubMed  Google Scholar 

  16. Liu L, Allison JE, Herrinton LJ. Validity of computerized diagnoses, procedures, and drugs for inflammatory bowel disease in a northern California managed care organization. Pharmacoepidemiol Drug Saf. 2009;18:1086–1093.

    Article  PubMed  Google Scholar 

  17. Hilsden RJ, Verhoef MJ, Best A, et al. A national survey on the patterns of treatment of inflammatory bowel disease in Canada. BMC Gastroenterol. 2003;3:10.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Hoie O, Wolters FL, Riis L, et al. Low colectomy rates in ulcerative colitis in an unselected European cohort followed for 10 years. Gastroenterology. 2007;132:507–515.

    Article  PubMed  Google Scholar 

  19. Vind I, Riis L, Jess T, et al. Increasing incidences of inflammatory bowel disease and decreasing surgery rates in Copenhagen City and County, 2003–2005: a population-based study from the Danish Crohn colitis database. Am J Gastroenterol. 2006;101:1274–1282.

    Article  PubMed  Google Scholar 

  20. Kappelman MD, Bousvaros A, Hyams J, et al. Intercenter variation in initial management of children with Crohn’s disease. Inflamm Bowel Dis. 2007;13:890–895.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lisa J. Herrinton.

Additional information

The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Li, D., Collins, B., Velayos, F.S. et al. Racial and Ethnic Differences in Health Care Utilization and Outcomes Among Ulcerative Colitis Patients in an Integrated Health-Care Organization. Dig Dis Sci 59, 287–294 (2014). https://doi.org/10.1007/s10620-013-2908-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-013-2908-2

Keywords

Navigation