Racial and geographic disparities in the use of parenteral nutrition among inflammatory bowel disease inpatients diagnosed with malnutrition in the United States

Abstract

Background: Racial disparities have been described in the use of a diverse spectrum of surgical procedures. The objectives of this study are to determine whether disparities also exist for the use of parenteral nutrition (PN) in inflammatory bowel disease (IBD).

Methods: The U.S. Nationwide Inpatient Sample between 1998 and 2003 is analyzed to determine PN use among IBD inpatients diagnosed with protein-calorie malnutrition and assess whether use patterns differ by race and geographical region.

Results: The proportion of African American IBD admissions with protein-calorie malnutrition who receive PN is significantly lower than that in whites (19.9% vs 28.1%, P = .001), whereas there is no difference between Hispanics and non-Hispanic whites. After adjustment for gender, comorbidity, health insurance status, geographic region, and median neighborhood income, African Americans remain less likely than whites to receive PN (odds ratio [OR] 0.67; 95% confidence interval [CI], 0.50-0.89), whereas the difference between Hispanics and non-Hispanic whites is marginally significant (OR 0.65; 95% CI, 0.41-1.04). PN use varies geographically, with highest rates in the Northeast (44.3%) and lowest in the Midwest (17.3%). Uninsured patients are less than half as likely to receive PN as those with insurance (OR 0.46; 95% CI, 0.31-0.69). Compared with whites, Hispanics experience a longer time interval between admission and initiation of PN (3.5 vs 4.8 days, P = .02) and have higher rates of catheter-related complications (5.1% vs 12.2%, P = .04).

Conclusions: Among IBD inpatients with clinically diagnosable malnutrition, PN use is lower among African Americans compared with whites. The underlying mechanisms of these racial variations merit further investigation.

Figure 1

Sociodemographic and Clinical Predictors for Receiving Parenteral Nutrition. The adjusted odds ratios for the association between sociodemographic and clinical variables and the likelihood of receiving parenteral nutrition are graphically depicted (solid boxes) with corresponding 95% confidence intervals. Reference categories are shown as solid circles. These values are numerically shown to the right. Each odds ratio is simultaneously adjusted for all other variables.