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News

Race and socioeconomic status influences immunomodulator use among IBD patients in the USA

A study in this month's American Journal of Gastroenterology examines the effect of race and socioeconomic status on immunomodulator and anti-tumor necrosis factor use among ambulatory patients with IBD in the United States.

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Health-care disparities exist for patients of minority race and low socioeconomic status (SES) in many chronic disease states, but little is known regarding health-care disparities for patients with inflammatory bowel disease (IBD).

Using nationally representative data, Drs Kirk Lin and Justin Sewell from California, USA determined whether use of immunomodulators and anti-tumor necrosis factor (TNF) agents differed by race/ethnicity and SES among ambulatory patients with IBD.

The researchers used data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 1998 to 2010.

The team identified visits associated with IBD and the medications associated with those visits.

Race/ethnicity and socioeconomic status were characterized.

The frequency of immunomodulator and anti-TNF use over time was assessed.

The researchers performed analyses accounting for the survey's complex multistage probability sampling design.

The proportion of visits associated with immunomodulators increased from 6 to 13%
American Journal of Gastroenterology

Associations between race/ethnicity, socioeconomic status and IBD medication use were identified.

A total of 26,400,000 visits for patients with IBD occurred in the United States from 1998 to 2010.

The team found that 76% of visits were for whites, 9% were for blacks, 7% were for Hispanics, and 2% were for Asians.

The researchers observed that 61% of visits were privately insured, whereas 7% had Medicaid coverage.

From 1998 to 2010, the proportion of visits associated with immunomodulators increased from 6 to 13%, whereas the proportion associated with anti-TNF agents increased from <1 to 14%.

In adjusted analyses, the team noted that visits with Medicaid were 3 times more likely to be associated with immunomodulators than visits with private insurance, but there were no race/ethnicity-based differences in immunomodulator use.

There were no race/ethnicity- or socioeconomic status-based differences in anti-TNF therapy.

Dr Sewell's and colleague comment, "Using nationally representative data over a 13-year time period, we found no evidence of disparities in medical therapy for IBD among visits with minority race/ethnicity or low socioeconomic status."

Am J Gastroenterol 2013; 108: 1824–1830
05 December 2013

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