Race, Insurance Status Linked to Poor Outcomes in Hospitalized UC Patients

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

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

Lower odds of colectomy were seen in Black (aOR 0.46, 95% CI 0.39-0.55) and Hispanic (aOR 0.74, 95% CI 0.64-0.86) patients versus white patients, the findings in Gastro Hep Advances showed.

“The adverse outcomes in ulcerative colitis associated with minority 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 those with Medicare (aOR 0.54, 95% CI 0.48-0.62), Medicaid (aOR 0.51, 95% CI 0.45-0.58), or no insurance (aOR 0.42, 95% CI 0.35-0.50) compared with those who were privately insured.

In addition, length of hospital stay was 5% longer for patients with Medicare (average 6.4 days) and 9% longer for those on Medicaid (5.9 days) compared with those with private insurance (5.4 days), while uninsured patients had a 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 with white patients ($55,500).

UC predominantly affects white patients, leading to disparities in care for minorities, Maddox’s group noted. Research has shown that UC is rising among minorities, with rates increasing by 134% from 1970 to 2010 versus 39% for white patients.

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

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

Of the included patients, 28% were ages 35-54, 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 the patients, the mean weighted Elixhauser comorbidity index score was 8; 46% had fluid/electrolyte disorders, and 28% had uncontrolled hypertension. The most common indication for admission was gastrointestinal hemorrhage/coagulopathy, except in Medicare patients, who were commonly admitted for infection or abscess.

Analyses were adjusted for sex, 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 treatments. In addition, findings may only apply to hospitalized patients, and race/ethnicity was hospital-reported, not patient-reported.