Racial and Ethnic Differences in Health Care Utilization and Outcomes Among Ulcerative Colitis Patients in an Integrated Health-Care Organization
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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.
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.
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.
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.
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- Racial and Ethnic Differences in Health Care Utilization and Outcomes Among Ulcerative Colitis Patients in an Integrated Health-Care Organization
Digestive Diseases and Sciences
Volume 59, Issue 2 , pp 287-294
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Ulcerative colitis
- Health services research
- Computerized medical information
- Outcomes research
- Race and/or ethnic differences
- Industry Sectors
- Author Affiliations
- 1. Department of Gastroenterology, Kaiser Permanente Northern California, Santa Clara, CA, USA
- 2. Division of Research, Kaiser Permanente Northern California, 2000 Broadway Avenue, Oakland, CA, 94612, USA
- 3. Division of Gastroenterology, Department of Internal Medicine, University of California, San Francisco, CA, USA
- 4. Department of Medicine, Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
- 5. Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- 6. Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA
- 7. Division of Pediatric Gastroenterology, Kaiser Permanente, Santa Clara, CA, USA