Insurance

Race, insurance status linked to poor outcomes in patients hospitalized for UC

According to a nationally representative cohort study, race/ethnicity and insurance status were associated with poor outcomes in hospitalized patients with ulcerative colitis (UC).

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

Lower odds 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, the results in Gastro Hep Advances show.

“The adverse effects of ulcerative colitis associated with race or ethnicity are multifactorial and likely related to the interplay of interpersonal and structural racism and its consequences, including access to care,” they wrote. .

Lower odds of colectomy were also noted for people on Medicare (aOR 0.54, 95% CI 0.48-0.62), Medicaid (aOR 0.51, 95% CI 0.45- 0.58) or without insurance (ORa 0.42, 95% CI 0.35-0.50) compared with those who had private insurance.

Additionally, length of hospital stay was 5% longer for patients on Medicare (6.4 days on average) and 9% longer for those on Medicaid (5.9 days) compared to those with private insurance (5.4 days), while uninsured patients had 6% shorter 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 primarily affects white patients, leading to disparities in care for minorities, Maddox’s group noted. Research has shown that UC is rising among minoritieswith rates increasing by 134% from 1970 to 2010 versus 39% for white patients.

“While investigating the reasons for these disparities goes beyond administrative data, it is possible that racial biases are present both among physicians and risk algorithms when identifying and treating patients with severe ulcerative colitis,” they wrote, noting that black patients are also generally less likely to seek care due to a historical mistrust of the healthcare system.

For this study, Maddox and colleagues looked at National Inpatient Sample data on 34,814 patients from January 2016 to December 2018. UC diagnoses were confirmed by ICD-10 codes.

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

Among patients, the weighted mean Elixhauser Comorbidity Index score was 8; 46% had fluid/electrolyte disturbances and 28% had uncontrolled hypertension. The most common indication for admission was gastrointestinal bleeding/coagulopathy, except in Medicare patients, who were frequently admitted for infection or abscess.

Analyzes were adjusted for gender, age, patient location, hospital region, comorbidities, income, and predictors of race/ethnicity and insurance.

The authors acknowledged that their study lacked detailed clinical data on disease severity and prior outpatient treatment. Also, the results may only apply to hospitalized patients, and race/ethnicity was reported by the hospital, not the patient.

  • Zaina Hamza is a writer for MedPage Today, covering gastroenterology and infectious diseases. She is based in Chicago.

Disclosures

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

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

The co-authors disclosed support from the ACC/ABC Merck Fellowship and academic clinical/laboratory training in gastroenterology.