Racial and Ethnic Disparities in Health-Related Outcomes in Crohn's Disease: Results From the National Health and Wellness Survey

Sabree C Burbage; Kathryn L Krupsky; M Janelle Cambron-Mellott; Nate Way; Aarti A Patel; Julia J Liu

doi:10.1093/crocol/otae021

Racial and Ethnic Disparities in Health-Related Outcomes in Crohn's Disease: Results From the National Health and Wellness Survey

Crohns Colitis 360. 2024 Apr 12;6(2):otae021. doi: 10.1093/crocol/otae021. eCollection 2024 Apr.

Authors

Sabree C Burbage¹, Kathryn L Krupsky², M Janelle Cambron-Mellott², Nate Way², Aarti A Patel¹, Julia J Liu³

Affiliations

¹ Population Health Research, Janssen Scientific Affairs, LLC, Horsham, PA, USA.
² Real-World Evidence, Cerner Enviza, an Oracle Company, Kansas City, MO, USA.
³ Division of Gastroenterology, Morehouse School of Medicine, Atlanta, GA, USA.

Abstract

Background: Crohn's disease (CD) is a chronic inflammatory condition affecting the entire gastrointestinal tract that is associated with significant humanistic, clinical, and economic burdens. Few studies have assessed the association between CD severity and patient-reported outcomes (PROs), healthcare resource utilization (HCRU), and medical costs; even fewer have examined differences in disease outcomes among patients of various racial/ethnic groups.

Methods: In this cross-sectional study, sociodemographic data, PROs, and economic outcomes for participants with self-reported CD were collected from the National Health and Wellness Survey (2018-2020). Multivariable analyses were used to assess the association of CD severity and race/ethnicity with health-related quality of life (HRQoL), work productivity and activity impairment (WPAI), HCRU, and medical costs.

Results: Analyses included 1077 participants with CD (818 non-Hispanic White, 109 non-Hispanic Black, and 150 Hispanic). Participants with self-reported moderate/severe CD reported significantly worse HRQoL and WPAI, greater HCRU, and higher medical costs than those with self-reported mild CD. Non-Hispanic Black participants reported better HRQoL and fewer healthcare provider visits than non-Hispanic White participants. There were no significant differences in PROs between non-Hispanic White and Hispanic groups. Interactions between race/ethnicity and CD severity emerged for some, but not all groups: Specifically, non-Hispanic Black participants with moderate/severe CD reported greater absenteeism and more gastroenterologist visits than non-Hispanic Black participants with mild CD.

Conclusions: Participants with moderate/severe CD reported worse PROs, greater HCRU, and higher medical costs than those with mild CD. Additionally, racial/ethnic differences were found across several HCRU and economic outcomes. Further research is needed to better understand factors contributing to burden among patients with varying CD severity across racial/ethnic groups.

Keywords: Crohn’s disease; National Health and Wellness Survey; condition severity; inflammatory bowel disease; race/ethnicity.