No racial disparities observed in IBD treatment among Medicaid patients
SAN ANTONIO — Researchers investigating racial disparities in health care found no significant difference in the use of biologics or other inflammatory bowel disease-specific treatments among black patients and white patients with the condition, according to an analysis of Medicaid data presented at the American College of Gastroenterology Annual Meeting.
However, Edward Barnes, MD, assistant professor of medicine at the University of North Carolina at Chapel Hill, and colleagues found that black patients were more likely than white patients to receive combination therapy for Crohn’s disease and initiate an immunomodulator after intestinal resection for Crohn’s disease.
“We believe that these findings may imply that changes in health policy to improve access to appropriate therapy would aid significantly in resolving apparent health care disparities,” Barnes said during the presentation. “And thus, we believe that future efforts to improve access to therapy would go a significant way to improve the apparent disparity outcomes that have been present in prior literature.”
Previous data have shown that phenotypes of Crohn’s disease and ulcerative colitis differ between black patients and white patients, according to Barnes. Multiple other disparities also have been described, with black patients requiring more emergency department visits, having decreased access to IBD specialists and IBD-related treatments such as Remicade (infliximab, Janssen), and having higher rates of IBD-related mortality.
“These disparities in outcomes could be secondary to differences in biology, such as phenotypes, but there could also be underlying differences in care delivery, or importantly, differences in access to care,” Barnes said.
Barnes and colleagues investigated whether racial disparities in care persist when all patients have access to the same insurance.
“If you have a pool where everybody has the same insurance, we thought that maybe [everybody] would have access to appropriate therapy and that these disparities would go away,” he said.
The researchers compared patterns of medication use and postoperative therapy among black patients and white patients with IBD using data from the Medicaid Analytic Extract from California, Georgia, North Carolina and Texas between 2006 and 2011. The researchers performed bivariate analyses and multivariable logistic regression to control for potential confounders.
IBD was identified in 14,735 patients (32% black patients; 58% with Crohn’s disease). Throughout the study, 64% of all patients received at least one IBD-specific medication and 398 underwent an intestinal resection for Crohn’s disease with an eligible time period for analysis of post-operative therapy use.
Results presented at the meeting did not show significant racial disparities in IBD-specific treatments. However, 31% of black patients received an immunomodulator after surgery for Crohn’s disease vs. 18% of white patients (P < .004). Further, 5% of black patients received combination therapy for the treatment of Crohn’s disease (anti-TNF plus an immunomodulator) vs. 3% of white patients (P < .001).
“We know that black patients are more likely to have perianal disease [and] black patients are more likely to have fistulizing disease. So, in reality, this might be good,” Barnes said. “If black patients are more likely to have combination therapy ... [and] biologic therapy for this particular analysis, that might be a good thing because we cannot account for severity in administrative claims, so this might actually show that the disparities are going away and they are actually getting appropriate therapy, whereas in earlier analyses from single centers, there was a disparity where they were less likely to get infliximab and combination [therapy].” – by Erin T. Welsh
Barnes E, et al. Abstract 60. Presented at: American College of Gastroenterology Annual Meeting; Oct. 25-30, 2019; San Antonio.
Disclosure: Barnes reports being a consultant for AbbVie. Please see the abstract for all other authors’ relevant financial disclosures.