Racial disparities in utilization of specialist care and medications in inflammatory bowel disease

Background: Previous reports on racial disparities in the treatment of Crohn's disease [CD] [smoking], race remained a statistically significant factor in postoperative complication rate. Only after additional adjustment was made for comorbidities and American Society of Anesthesiologists class did race lose significance within our model. Conclusion: African Americans experience a greater amount of postoperative complications following surgery for Crohn's disease. Preoperative disease management, addressing smoking status and control of comorbid disease are important factors in addressing the racial disparities in the surgical treatment of Crohn's disease.

Section: Introductionmentioning

confidence: 99%

African Americans and Short-Term Outcomes after Surgery for Crohn’s Disease: An ACS-NSQIP Analysis

Arsoniadis

Melton

et al. 2016

ECCOJC

“…This level of expenditure detail is especially important in a disease such as IBD where a wide range of services and treatments and associated costs exist, potentially revealing patterns that total expenditure figures alone fail to capture. 8,11,13 Using nationally representative data from 1996 to 2011, we determined that mean inpatient expenditures composed the highest proportion of IBD direct costs, above outpatient, emergency, office-based, and prescribed medicine costs. When IBD patients were stratified by insurance status, we found that publicly insured patients spent over double the mean expenditures of privately insured or uninsured patients, with differences of $10K and $13K, respectively.…”

Section: Discussionmentioning

confidence: 99%

Section: ) a Mo N G A L L I B D P A T I E N T S I N P A T I E N Tmentioning

confidence: 99%

Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting

Bhattacharya

2014

Preprint

View the peer-reviewed version (peerj.com/articles/587), which is the preferred citable publication unless you specifically need to cite this preprint.Park MD, Bhattacharya J, Park K. 2014. Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting. PeerJ 2:e587 https://doi.org/10.7717/peerj.587Di ff e r e n c e s i n h e a l t h c a r e e x p e n d i t u r e s f o r i n fl a mma t o r y b o we l d i s e a s e b y i n s u r a n c e s t a t u s , i n c o me , a n d c l i n i c a l c a r e s e t t i n g Ba c k g r o u n d : S o c i o e c o n o mi c f a c t o r s a n d i n s u r a n c e s t a t u s h a v e n o t b e e n c o r r e l a t e d wi t h d i ff e r e n t i a l u s e o f h e a l t h c a r e s e r v i c e s i n i n fl a mma t o r y b o we l d i s e a s e ( I B D) . Ai m: T o d e s c r i b e I B D-r e l a t e d e x p e n d i t u r e s b a s e d o n i n s u r a n c e a n d h o u s e h o l d i n c o me wi t h t h e u s e o f i n p a t i e n t , o u t p a t i e n t , e me r g e n c y , a n d o ffi c e -b a s e d s e r v i c e s , a n d p r e s c r i b e d me d i c a t i o n s i n t h e Un i t e d S t a t e s ( US ) . Me t h o d s :We e v a l u a t e d t h e Me d i c a l E x p e n d i t u r e P a n e l S u r v e y f r o m 1 9 9 6 t o 2 0 1 1 o f i n d i v i d u a l s wi t h Cr o h n ' s d i s e a s e ( CD) o r u l c e r a t i v e c o l i t i s ( UC) . Na t i o n a l l ywe i g h t e d me a n s , p r o p o r t i o n s , a n d mu l t i v a r i a t e r e g r e s s i o n mo d e l s e x a mi n e d t h e r e l a t i o n s h i p s b e t we e n i n c o me a n d i n s u r a n c e s t a t u s wi t h e x p e n d i t u r e s . Re s u l t s : A n n u a l p e r c a p i t a me a n e x p e n d i t u r e s f o r CD, UC, a n d a l l I B D we r e $ 1 0 , 3 6 4 ( N= 2 3 8 ) , $ 7 , 8 2 7 ( N= 9 5 ) , a n d $ 9 , 5 2 8 , r e s p e c t i v e l y , s i g n i fi c a n t l y h i g h e r t h a n n o n -I B D ( $ 4 , 3 1 4 , N= 2 7 6 , 3 7 2 , p < 0 . 0 5 ) . P u b l i c l y i n s u r e d p a t i e n t s i n c u r r e d t h e h i g h e s t c o s t s ( $ 1 8 , 0 6 7 ) , o v e r p r i v a t e l y i n s u r e d ( $ 8 , 0 1 4 , p < 0 . 0 5 ) o r u n i n s u r e d p a t i e n t s ( $ 5 , 1 2 9 , p < 0 . 5 ) . A mo n g a l l I B D p a t i e n t s , i n p a t i e n t c a r e c o mp o s e d t h e h i g h e s t p r o p o r t i o n o f c o s t s ( $ 3 , 3 9 2 , p < . 5 ) . I n p a t i e n t c o s t s we r e d i s p r o p o r t i o n a t e l y h i g h e rf o r p u b l i c l y i n s u r e d p a t i e n t s . P u b l i c i n s u r a n c e h a d h i g h e r o d d s o f t o t a l c o s t s t h a n p r i v a t e ( OR 2 . 1 3 , CI 1 . 0 8 -4 . 1 9 ) o r n o i n s u r a n c e ( OR 4 . 9 4 , CI 1 . 2 6 -1 9 . 4 7 ) , wi t h i n c r e a s e d o d d s f o r i n p a t i e n t a n d e me r g e n c y c a r e . P r i v a t e i n s u r a n c e h a d h i g h e r c o s t s a s s o c i a t e d wi t h o u t p a t i e n t c a r e , o ffi c e -b a s e d c a r e , a n d p r e s c r i b e d me d i c i n e s ....

“…Black patients utilized less ambulatory care, specialists, and biologics than whites, while exhibiting increased hospitalization rates. [10][11][12][13] Race-related health disparities have also been demonstrated in IBD disease phenotype, surgery rates, type of surgery, perianal fistulizing disease, and extraintestinal manifestations. 2,14 Lower income was associated with higher rates of CD-related surgery along with higher IBD-related hospitalizations, emergency department (ED) visits, and physician visits.…”

mentioning

confidence: 99%

Differences in healthcare expenditures for inflammatory bowel disease by insurance status, income, and clinical care setting

Bhattacharya

2014

Preprint

View the peer-reviewed version (peerj.com/articles/587), which is the preferred citable publication unless you specifically need to cite this preprint. expenditures for CD, UC, and all IBD were $10,364 (N=238), $7,827 (N=95), and $9,528, respectively, significantly higher than non-IBD ($4,314, N=276,372, p<0.05). Publicly insured patients incurred the highest costs ($18,067), over privately insured ($8,014, p<0.05) or uninsured patients ($5,129, p<0.05). Among all IBD patients, inpatient care composed the highest proportion of costs ($3,392, p<0.05). Inpatient costs were disproportionately higher for publicly insured patients. Public insurance had higher odds of total costs than private (OR 2.13, CI 1.08-4.19) or no insurance (OR 4.94,, with increased odds for inpatient and emergency care. Private insurance had higher costs associated with outpatient care, office-based care, and prescribed medicines. Low-income patients had lower costs associated with outpatient (OR 0.38, CI 0.15-0.95) and office-based care (OR 0.21, CI 0.07-0.62). Conclusions: In the US, high inpatient utilization among publicly insured patients is a previously unrecognized driver of high IBD costs. Bridging this health services gap between SES strata for acute care services may curtail direct IBD-related costs. Disclosures: Authors report no conflicts of interest as described by PeerJAuthor Contributions: Michelle D Park, BA -obtaining funding source, planning and conducting the study, collecting and interpreting data, and drafting/editing the manuscript. Jay Bhattacharya, MD, PhD -planning the study, interpreting data, and editing the manuscript. KT Park, MD, MS -obtaining funding source, planning and conducting the study, collecting and interpreting data, and drafting/editing the manuscript. Aim: To describe IBD-related expenditures based on insurance and household income with the use of inpatient, outpatient, emergency, and office-based services, and prescribed medications in the United States (US). Methods:We evaluated the Medical Expenditure Panel Survey from 1996 to 2011 of individuals with Crohn's disease (CD) or ulcerative colitis (UC). Nationally weighted means, proportions, and multivariate regression models examined the relationships between income and insurance status with expenditures.Results: Annual per capita mean expenditures for CD, UC, and all IBD were $10,364 (N=238), $7,827 (N=95), and $9,528, respectively, significantly higher than non-IBD ($4,314, N=276,372, p<0.05). Publicly insured patients incurred the highest costs ($18,067), over privately insured ($8,014, p<0.05) or uninsured patients ($5,129, p<0.05). Among all IBD patients, inpatient care composed the highest proportion of costs ($3,392, p<0.05). Inpatient costs were disproportionately higher for publicly insured patients. Public insurance had higher odds of total costs than private (OR 2.13, CI 1.08-4.19) or no insurance (OR 4.94,, with increased odds for inpatient and emergency care. Private insurance had higher costs associated with outpatient care, office-b...