Racial disparity in healthcare utilization among patients with Irritable Bowel Syndrome: results from a multicenter cohort

Abstract

Irritable bowel syndrome (IBS) is a functional GI disorder (FGID) defined by recurrent abdominal pain associated with a change in the frequency and/or form of stool. The prevalence of IBS is estimated to be as high as 9.2% of the global population. 1 IBS is highly correlated with psychological, social, and environmental factors, and thus, healthcare disparities, specifically racial disparities, could be an important factor in the sociocultural model of IBS. 1 Racial disparity in healthcare reflects differences in healthcare services by race that are independent of underlying healthcare needs or preferences. 2 The term "disparity" implies not only difference, but inherent inequality and unfairness as well. Racial disparities are common across the US healthcare system, 3 with outcomes, resource utilization, and engagement key measures of these disparities. 4 In a disease with few standardized, population-level outcome measures like IBS, healthcare resource utilization represents an ideal means to identify racial disparities.

Understanding racial disparities in the care of patients with irritable bowel syndrome: The need for a unified approach

“…Key study findings included the observation that a significantly greater proportion of individuals from ethnic minorities had their IBS managed in primary care with a lower proportion referred on to and managed by more specialist services in secondary care. 1 For black patients, 28.7% were seen by a gastroenterologist compared to 59.3% of matched controls (p = < 0.01); for Hispanic patients, the relationship was 39.0% compared to 69.5% (p = < 0.01), and for Asian patients, 17.9% versus 62.7% (p = < 0.01). 1 Furthermore, and rather surprisingly, ethnic minority patients being managed in secondary care were significantly more likely to be referred for gastrointestinal investigations.…”

“…1 For black patients, 28.7% were seen by a gastroenterologist compared to 59.3% of matched controls (p = < 0.01); for Hispanic patients, the relationship was 39.0% compared to 69.5% (p = < 0.01), and for Asian patients, 17.9% versus 62.7% (p = < 0.01). 1 Furthermore, and rather surprisingly, ethnic minority patients being managed in secondary care were significantly more likely to be referred for gastrointestinal investigations. 1 77.7% of Black patients were referred for investigations versus 50.5% of white controls (p = < 0.01); for Hispanic patients, the values were 71.8% compared to 49.4% (p = < 0.01), and for Asians, 62.8% versus 45.5% (p = < 0.01).…”

“…1 Furthermore, and rather surprisingly, ethnic minority patients being managed in secondary care were significantly more likely to be referred for gastrointestinal investigations. 1 77.7% of Black patients were referred for investigations versus 50.5% of white controls (p = < 0.01); for Hispanic patients, the values were 71.8% compared to 49.4% (p = < 0.01), and for Asians, 62.8% versus 45.5% (p = < 0.01). 1 Despite the study not being designed to identify the precise underlying reasons for observed racial differences, the authors concluded that these were potentially due reasons including communication difficulties, bias and socioeconomic status.…”

“…21 Furthermore, when present, IBS has also been shown to lead to a large negative impact on an individual's perceived quality of life. 23 Into this contextual landscape, Silvernale et al 1 published their large retrospective study investigating differences in IBS healthcare utilization between different racial groups. Healthcare utilization was chosen as an indirect measure of treatment outcomes as there are currently no standardized outcome measures for IBS.…”

“…Healthcare utilization was chosen as an indirect measure of treatment outcomes as there are currently no standardized outcome measures for IBS. 1 1733 patients from ethnic minorities with a documented diagnosis of IBS met the study inclusion criteria and were compared with 2090 age, gender, and comorbidity matched white patients from the same hospitals.…”