Socioeconomic Status and Race are both Independently associated with Increased Hospitalization Rate among Crohn’s Disease Patients

Abstract

Racial disparities are observed clinically in Crohn’s Disease (CD) with research suggesting African Americans (AA) have worse outcomes than Caucasian Americans (CA). The aim of this study is to assess whether socioeconomic status (SES) rather than race is the major predictor of worse outcomes. We designed a retrospective cohort study of 944 CD patients seen at our center. Patients’ billing zip codes were collected and average income and percent of population living above or below poverty level (PL) for each zip code calculated. Patients were separated by quartiles using average state income level and federal PL. Demographics and hospitalization rates were collected. Poison regression models estimated incidence rate ratios (IRR) for CD-related hospitalizations. Incidence rate (IR) of hospitalization per 100-person years for the lowest income group was 118 (CI 91.4–152.3), highest income group was 29 (CI 21.7–38.9), Above PL was 26.9 (25.9–28.9), Below PL was 35.9 (33.1–38.9), CA was 25.3 (23.7–27), and AA was 51.4 (46.8–56.3). IRR for a CD-related hospitalization for lowest income group was 2.01 (CI 1.34–3.01), for Below PL was 1.26 (CI 1.12–1.42), and for AAs was 1.88 (CI 1.66–2.12). SES and race are both associated with hospitalization among CD patients and need further investigation.

Inflammatory bowel disease in underserved populations: lessons for practice

“…Disparate outcomes have also been noted in hospitalizations, length of stay and readmissions. A single-centre retrospective study assessed rates of Crohn's disease hospitalizations by race and ethnicity and found hospitalizations were four times higher for those in the lowest income group compared with the highest income group on unadjusted analysis, and twice as high in an adjusted analysis [27]. In addition, Black patients in the study were twice as likely to have a Crohn's disease related hospitalization in comparison to white patients, illustrating the separate yet distinct disparities due to poverty and race/racism.…”

Epidemiology and Risk Factors for Hospitalization in Patients with Ulcerative Colitis and Crohn’s Disease

“…Lower-income levels were associated with higher hospitalization rate. In a retrospective analysis of CD patients, the incidence rate for hospitalization for lowest-income group was 118 per 100-person years (CI 91.4-152.3) and for the highest-income group was 29 (CI 21.7-38.9) [40]. In CD, smoking has also been shown to increase the risk of hospitalization [41].…”

Self‐Assembling Nanofibers Inhibit Inflammation in a Murine Model of Crohn's‐Disease‐Like Ileitis

“…[ 3,9–11 ] This spans the gamut of age, sex, race, socioeconomic conditions, and geographic locale and translates into $6–15 billion in direct healthcare costs in the United States. [ 3,12,13 ]…”