Race/Ethnicity-specific Disparities in In-Hospital Mortality and Hospital Charges Among Inflammatory Bowel Disease-related Hospitalizations in the United States

J Clin Gastroenterol. 2020 Aug;54(7):e63-e72. doi: 10.1097/MCG.0000000000001204.

Abstract

Goal: The goal of this study was to evaluate disparities in hospital outcomes among inflammatory bowel disease (IBD) related hospitalizations in the United States with a focus on ethnicity-specific disparities.

Background: IBD-related hospitalizations contribute to significant morbidity and health care economic burden.

Methods: IBD-related hospitalizations (identified with ICD-9) among US adults were evaluated using 2007 to 2013 Nationwide Inpatient Sample. In-hospital mortality between groups was evaluated using χ and multivariate logistic regression models, stratified by Crohn's disease (CD) and ulcerative colitis (UC). Inflation-adjusted total hospitalization charges were evaluated using Student t test and multivariate linear regression.

Results: Among 224,500 IBD-related hospitalizations (77.8% CD, 22.2% UC), overall in-hospital mortality was low (0.99% CD, 0.78% UC). Although Hispanic UC patients had a trend towards higher odds of in-hospital mortality compared with non-Hispanic whites (OR, 1.54; 95% CI, 0.95-2.51; P=0.08), no ethnicity-specific disparities were observed in CD. From 2007 to 2013, mean inflation-adjusted hospitalization charges increased from $29,632 to $41,484, P<0.01 in CD and from $31,449 to $43,128 in UC, P<0.01. On multivariate regression, hospitalization charges in Hispanic CD patients were $9302 higher (95% CI, 7910-10,694; P<0.01) and in Asian CD patients were $7665 higher (95% CI, 4859-10,451; P<0.001) than non-Hispanic whites. Compared with non-Hispanic white UC patients, Hispanics had $6910 (95% CI, $4623-$9197) higher charges and African Americans had $3551 lower charges (95% CI, -$5002 to -$2101).

Conclusions: Although most IBD hospitalizations in the United States were among non-Hispanic whites, Hispanic patients with IBD had a trend towards higher in-hospital mortality and contributed to significantly higher hospitalization charges.

MeSH terms

  • Adult
  • Colitis, Ulcerative* / therapy
  • Ethnicity
  • Hospital Charges
  • Hospital Mortality
  • Hospitalization
  • Hospitals
  • Humans
  • Inflammatory Bowel Diseases* / therapy
  • United States / epidemiology