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Black Race and Public Insurance Are Predictive of Inappropriate Evaluation of Iron Deficiency Anemia and Diarrhea

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Background and Aims

Socioeconomic status, race, and insurance can impact healthcare delivery and utilization in several chronic disease states. The primary aim of our study was to determine whether race and insurance status are predictors of having an appropriate workup for celiac disease and inflammatory bowel disease (IBD) when presenting with iron deficiency anemia (IDA) and chronic diarrhea.


Medical records of patients seen at the University of Chicago Medical Center between January 1, 2006, and September 20, 2017, were reviewed. Patients with two separate encounters within 6 months associated with the diagnosis codes for both IDA and chronic diarrhea were identified. Patients without a diagnosis code for IBD and celiac disease were further grouped as those that had an “appropriate” workup and those that did not. Factors associated with the appropriate evaluation were analyzed by univariate and multivariate logistic regression.


In total, 899,701 records were searched. A total of 83 patients fit inclusion into the study (8 IBD, 3 CD, 72 neither IBD or CD). Black race was associated with a 91% decreased odds of having the appropriate workup on univariate (OR 0.090, 95%CI 0.017–0.475, p = 0.005) and age-adjusted multivariate analysis (OR 0.095, 95% CI 0.017–0.527, p = 0.007). Public insurance status was significantly associated with a 90% decreased odds of appropriate workup on univariate (OR 0.102, 95% CI 0.024–0.438, p = 0.002) and age-adjusted multivariate analysis (OR 0.104, 95% CI 0.021–0.513, p = 0.005).


Black race and public insurance were significantly associated with not having an appropriate workup for IBD and celiac disease when presenting with iron deficiency and chronic diarrhea.

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Authors and Affiliations



AAY was involved in drafting of manuscript, data acquisition, analysis and interpretation, revision of manuscript, and drafting of tables and figures; BL was involved in data acquisition, drafting of manuscript, and tables and figures; CT was involved in data analysis and interpretation, and critical revision of manuscript; AIE was involved in data analysis and interpretation, and critical revision of manuscript; PS was involved in data analysis and interpretation, drafting of tables and figures, and critical revision of manuscript; VR was involved in data analysis and interpretation, drafting of tables and figures, and critical revision of manuscript; DTR was involved in study concept and design, drafting of manuscript, critical revision of manuscript, and final approval of manuscript.

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Correspondence to David T. Rubin.

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Anyane-Yeboa, A., Li, B., Traboulsi, C. et al. Black Race and Public Insurance Are Predictive of Inappropriate Evaluation of Iron Deficiency Anemia and Diarrhea. Dig Dis Sci 66, 2200–2206 (2021).

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