Towards Equitable Surgical Management of Inflammatory Bowel Disease: A Systematic Review of Disparities in Surgery for Inflammatory Bowel Disease

Abstract

Background Existing evidence for disparities in inflammatory bowel disease is fragmented and heterogenous. Underlying mechanisms for differences in outcomes based on race and socioeconomic status remain undefined. We performed a systematic review of the literature to examine disparities in surgery for inflammatory bowel disease in the United States. Methods Electronic databases were searched from 2000 through June 11, 2021, to identify studies addressing disparities in surgical treatment for adults with inflammatory bowel disease. Eligible English-language publications comparing the use or outcomes of surgery by racial/ethnic, socioeconomic, geographic, and/or institutional factors were included. Studies were grouped according to whether outcomes of surgery were reported or surgery itself was the relevant end point (utilization). Quality was assessed using the Newcastle-Ottawa Scale for observational studies. Results Forty-five studies were included. Twenty-four reported surgical outcomes and 21 addressed utilization. Race/ethnicity was considered in 96% of studies, socioeconomic status in 44%, geographic factors in 27%, and hospital/surgeon factors in 22%. Although study populations and end points were heterogeneous, Black and Hispanic patients were less likely to undergo abdominal surgery when hospitalized; they were more likely to have a complication when they did have surgery. Differences based on race were correlated with socioeconomic factors but frequently remained significant after adjustments for insurance and baseline health. Conclusions Surgical disparities based on sociologic and structural factors reflect unidentified differences in multidisciplinary disease management. A broad, multidimensional approach to disparities research with more granular and diverse data sources is needed to improve health care quality and equity for inflammatory bowel disease.

Global Hospitalization Trends for Crohn’s Disease and Ulcerative Colitis in the 21st Century: A Systematic Review With Temporal Analyses

“…[35][36][37] Despite advances in the ambulatory management of IBD, health system and societal factors also vary by geography and between individuals. [38][39][40] Differential access to health care and medications may be driven by variation in health insurance. 41 For example, regions such as the United States that lack universal health care may have impediments to routine access of ambulatory care, leading to the hospital/emergency department being the primary point of care.…”

Far From Home: The Role of Travel Distance and Care Fragmentation in Surgical Outcomes for Inflammatory Bowel Disease

“…There is strong evidence for significant disparities in IBD surgery outcomes based on race and socioeconomic status, but existing data for differences by geographic factors are very limited. 10 An analysis of colectomy for UC in the National Inpatient Sample found mortality was higher at rural hospitals, but less than 4% of operations occurred at rural locations. 20 Unfortunately, most nationally representative databases lack the granularity necessary to explore travel distance as a contributor to outcomes.…”

“…IBD patients with markers of low socioeconomic status are more likely to experience surgical complications. 10 Similarly, they are more likely to have 90-day readmission to a non-index hospital. 3 Increasing regional consolidation of specialty care also poses unique challenges in access to care for rural patients, for whom fragmentation may be a major driver in outcome disparities.…”

“… 14 , 15 There is a paucity of data on the effect of travel distance for IBD surgery outcomes, especially in the United States. 10 …”

Racial disparities in surgical treatment of oropharyngeal cancer: A Surveillance, Epidemiology, and End Results review

“…While head and neck squamous cell carcinoma (HNSCC) is the 6th leading cause of cancer worldwide 1 and makes up 90% of head and neck cancers, 2,3 little is known about surgical disparities within this disease group despite it being well established that surgical disparities exist among different races/ethnicities in other disease processes. [4][5][6][7] According to Booth et al, black and Hispanic patients were less likely to undergo surgery when hospitalized for inflammatory bowel disease. 4 Additionally, these patients were more likely to suffer complications from surgery.…”