Race, Insurance Status Associated with Poor Outcomes in Hospitalized UC Patients

Race/race and insurance are associated with poor outcomes among hospitalized patients with ulcerative colitis (UC), according to a nationally representative study.

Among the approximately 35,000 people included in this cohort, black patients had higher mortality rates than white patients (adjusted OR [aOR] 1.38, 95% CI 1.07–1.78, P= 0.010), said Karen Joynt Maddox, MD, MPH, of Washington University School of Medicine in St. Louis, and his friends.

Fewer complications of colectomy were observed in Black (aOR 0.46, 95% CI 0.39-0.55) and Hispanic (aOR 0.74, 95% CI 0.64-0.86) patients compared to white patients, which was found in Effects of Gastro Hep showed.

“The adverse effects of ulcerative colitis associated with racial or ethnic minorities are disparate, and may be related to differences in social discrimination and its causes and outcomes, including access to treatment,” they wrote.

Fewer colectomy complications were also noted in those with Medicare (aOR 0.54, 95% CI 0.48-0.62), Medicaid (aOR 0.51, 95% CI 0.45-0.58), or no insurance (aOR 0.42, 95% CI-0.53) compared with who were privately insured.

In addition, length of hospital stay was 5% longer for patients with Medicare (6.4 days) and 9% longer for those on Medicaid (5.9 days) compared to those with private insurance (5.4 days), while uninsured patients had 6%. short stay (4.9 days).

Of note, hospitalization costs were 11% higher for Hispanic patients ($63,200) and 13% higher for Asian and Native American patients ($69,200) compared to white patients ($55,500).

UC predominantly affects white patients, which creates disparities in care for minorities, Maddox’s team said. Studies have shown that UC is rising among the minorityrates increased by 134% from 1970 to 2010 versus 39% for white patients.

“Although investigating the reasons for this difference is not possible for the management system, it is possible that a bias exists between doctors and risk algorithms in identifying and treating patients with ulcers,” they wrote, referring to Black patients. they also often do not seek treatment because of a lack of medical trust.

For this study, Maddox and his colleagues analyzed data from the National Inpatient Sample on 34,814 patients from January 2016 to December 2018. The diagnosis of UC was confirmed by ICD-10 codes.

Of the included patients, 28% were 35-54 years old, 53% were female, 74% were white, and 11% were black. About half (42%) had private insurance, 36% had Medicare, and 15% had Medicaid. Only 8% were uninsured.

Among patients, the minimum Elixhauser comorbidity index was 8; 46% had fluid/electrolyte problems, and 28% had uncontrolled hypertension. The most common admission indication was gastrointestinal bleeding/coagulopathy, except for Medicare patients, who were usually admitted for infection or abscess.

Analyzes were adjusted for sex, age, patient location, clinical region, comorbidities, income, and predictors for race/ethnicity and insurance.

The authors acknowledged that their study lacked clinical data on disease severity and primary care. Furthermore, the findings could be applied to hospitalized patients, and race/ethnicity was reported in the hospital, not the patient.

  • Zaina Hamza is a staff writer for MedPage Today, covering Gastroenterology and Infectious Diseases. He lives in Chicago.

Disclosures

This study was supported by the Mentors in Medicine Program at Washington University School of Medicine.

Maddox also reported relationships with the National Heart, Lung, and Blood Institute, the National Institute on Aging, the Health Policy Advisory Council for the Cetene Corporation in St. Louis, and the US Department of Health and Human Services.

The co-authors disclosed support from ACC/ABC Merck Research Fellowship and Clinical/Laboratory Training Academic Gastroenterology.