Disability in inflammatory bowel disease patients is associated with race, ethnicity and socio-economic factors

Manasi Agrawal, Shirley Cohen-Mekelburg, Maia Kayal, Jordan Axelrad, Jonathan Galati, Brad Tricomi, Kanika Kamal, Adam S. Faye, Paul Abrudescu, Ellen Scherl, Garrett Lawlor, Keith Sultan, Dana J. Lukin, Jean Frederic Colombel, Ryan C. Ungaro

Research output: Contribution to journalArticle

Abstract

Background: Race, ethnicity and socio-economic status impact clinical outcomes in inflammatory bowel disease (IBD) patients. However, their impact on disability has not been studied. Aim: To determine the association between race, ethnicity and socio-economic factors with disability in IBD, using the validated IBD disability index (IBD-DI). Methods: Ambulatory IBD patients were enrolled at five academic centres participating in the New York Crohn's and Colitis Organization. We assessed the IBD-DI, and collected clinical and socio-economic data. Factors associated with moderate-to-severe disability (IBD-DI score > 35) on univariable analysis were tested in multivariable models with adjusted odds ratios (aOR) and 95% confidence intervals (CI) reported. Results: In this study, 323 patients (57.3% CD, 51.4% female) were enrolled; 17.7% were Hispanic, 17% were non-Hispanic black, 56.0% were non-Hispanic Caucasian and 9.3% belonged to non-Hispanic non-black minority races. However, 39.0% of patients were publicly insured and 38.4% of patients had low annual household income (<$50 000). 100 (31.0%) patients reported moderate-to-severe disability. On multivariable analysis, Hispanic ethnicity (aOR 2.7, 95% CI 1.3-5.6), non-Hispanic non-black minority race (aOR 3.5, 95% CI 1.3-8.9), public payer (aOR 2.1, 95% CI 1.1-4.0) and low annual household income (aOR 3.0, 95% CI 1.7-5.4) were associated with moderate-to-severe disability controlling for disease characteristics. Conclusions: IBD patients who are minorities, have public insurance, or low household income, are 2-3 times more likely to report moderate-to-severe disability independent of disease characteristics in the United States. Future studies are needed to study their complex relationship and to mitigate disability.

LanguageEnglish (US)
JournalAlimentary Pharmacology and Therapeutics
DOIs
StateAccepted/In press - Jan 1 2019

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Inflammatory Bowel Diseases
Economics
Odds Ratio
Confidence Intervals
Hispanic Americans
Colitis
Insurance
Organizations

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)

Cite this

Agrawal, M., Cohen-Mekelburg, S., Kayal, M., Axelrad, J., Galati, J., Tricomi, B., ... Ungaro, R. C. (Accepted/In press). Disability in inflammatory bowel disease patients is associated with race, ethnicity and socio-economic factors. Alimentary Pharmacology and Therapeutics. https://doi.org/10.1111/apt.15107

Disability in inflammatory bowel disease patients is associated with race, ethnicity and socio-economic factors. / Agrawal, Manasi; Cohen-Mekelburg, Shirley; Kayal, Maia; Axelrad, Jordan; Galati, Jonathan; Tricomi, Brad; Kamal, Kanika; Faye, Adam S.; Abrudescu, Paul; Scherl, Ellen; Lawlor, Garrett; Sultan, Keith; Lukin, Dana J.; Colombel, Jean Frederic; Ungaro, Ryan C.

In: Alimentary Pharmacology and Therapeutics, 01.01.2019.

Research output: Contribution to journalArticle

Agrawal, M, Cohen-Mekelburg, S, Kayal, M, Axelrad, J, Galati, J, Tricomi, B, Kamal, K, Faye, AS, Abrudescu, P, Scherl, E, Lawlor, G, Sultan, K, Lukin, DJ, Colombel, JF & Ungaro, RC 2019, 'Disability in inflammatory bowel disease patients is associated with race, ethnicity and socio-economic factors', Alimentary Pharmacology and Therapeutics. https://doi.org/10.1111/apt.15107
Agrawal, Manasi ; Cohen-Mekelburg, Shirley ; Kayal, Maia ; Axelrad, Jordan ; Galati, Jonathan ; Tricomi, Brad ; Kamal, Kanika ; Faye, Adam S. ; Abrudescu, Paul ; Scherl, Ellen ; Lawlor, Garrett ; Sultan, Keith ; Lukin, Dana J. ; Colombel, Jean Frederic ; Ungaro, Ryan C. / Disability in inflammatory bowel disease patients is associated with race, ethnicity and socio-economic factors. In: Alimentary Pharmacology and Therapeutics. 2019.
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abstract = "Background: Race, ethnicity and socio-economic status impact clinical outcomes in inflammatory bowel disease (IBD) patients. However, their impact on disability has not been studied. Aim: To determine the association between race, ethnicity and socio-economic factors with disability in IBD, using the validated IBD disability index (IBD-DI). Methods: Ambulatory IBD patients were enrolled at five academic centres participating in the New York Crohn's and Colitis Organization. We assessed the IBD-DI, and collected clinical and socio-economic data. Factors associated with moderate-to-severe disability (IBD-DI score > 35) on univariable analysis were tested in multivariable models with adjusted odds ratios (aOR) and 95{\%} confidence intervals (CI) reported. Results: In this study, 323 patients (57.3{\%} CD, 51.4{\%} female) were enrolled; 17.7{\%} were Hispanic, 17{\%} were non-Hispanic black, 56.0{\%} were non-Hispanic Caucasian and 9.3{\%} belonged to non-Hispanic non-black minority races. However, 39.0{\%} of patients were publicly insured and 38.4{\%} of patients had low annual household income (<$50 000). 100 (31.0{\%}) patients reported moderate-to-severe disability. On multivariable analysis, Hispanic ethnicity (aOR 2.7, 95{\%} CI 1.3-5.6), non-Hispanic non-black minority race (aOR 3.5, 95{\%} CI 1.3-8.9), public payer (aOR 2.1, 95{\%} CI 1.1-4.0) and low annual household income (aOR 3.0, 95{\%} CI 1.7-5.4) were associated with moderate-to-severe disability controlling for disease characteristics. Conclusions: IBD patients who are minorities, have public insurance, or low household income, are 2-3 times more likely to report moderate-to-severe disability independent of disease characteristics in the United States. Future studies are needed to study their complex relationship and to mitigate disability.",
author = "Manasi Agrawal and Shirley Cohen-Mekelburg and Maia Kayal and Jordan Axelrad and Jonathan Galati and Brad Tricomi and Kanika Kamal and Faye, {Adam S.} and Paul Abrudescu and Ellen Scherl and Garrett Lawlor and Keith Sultan and Lukin, {Dana J.} and Colombel, {Jean Frederic} and Ungaro, {Ryan C.}",
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AU - Agrawal, Manasi

AU - Cohen-Mekelburg, Shirley

AU - Kayal, Maia

AU - Axelrad, Jordan

AU - Galati, Jonathan

AU - Tricomi, Brad

AU - Kamal, Kanika

AU - Faye, Adam S.

AU - Abrudescu, Paul

AU - Scherl, Ellen

AU - Lawlor, Garrett

AU - Sultan, Keith

AU - Lukin, Dana J.

AU - Colombel, Jean Frederic

AU - Ungaro, Ryan C.

PY - 2019/1/1

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N2 - Background: Race, ethnicity and socio-economic status impact clinical outcomes in inflammatory bowel disease (IBD) patients. However, their impact on disability has not been studied. Aim: To determine the association between race, ethnicity and socio-economic factors with disability in IBD, using the validated IBD disability index (IBD-DI). Methods: Ambulatory IBD patients were enrolled at five academic centres participating in the New York Crohn's and Colitis Organization. We assessed the IBD-DI, and collected clinical and socio-economic data. Factors associated with moderate-to-severe disability (IBD-DI score > 35) on univariable analysis were tested in multivariable models with adjusted odds ratios (aOR) and 95% confidence intervals (CI) reported. Results: In this study, 323 patients (57.3% CD, 51.4% female) were enrolled; 17.7% were Hispanic, 17% were non-Hispanic black, 56.0% were non-Hispanic Caucasian and 9.3% belonged to non-Hispanic non-black minority races. However, 39.0% of patients were publicly insured and 38.4% of patients had low annual household income (<$50 000). 100 (31.0%) patients reported moderate-to-severe disability. On multivariable analysis, Hispanic ethnicity (aOR 2.7, 95% CI 1.3-5.6), non-Hispanic non-black minority race (aOR 3.5, 95% CI 1.3-8.9), public payer (aOR 2.1, 95% CI 1.1-4.0) and low annual household income (aOR 3.0, 95% CI 1.7-5.4) were associated with moderate-to-severe disability controlling for disease characteristics. Conclusions: IBD patients who are minorities, have public insurance, or low household income, are 2-3 times more likely to report moderate-to-severe disability independent of disease characteristics in the United States. Future studies are needed to study their complex relationship and to mitigate disability.

AB - Background: Race, ethnicity and socio-economic status impact clinical outcomes in inflammatory bowel disease (IBD) patients. However, their impact on disability has not been studied. Aim: To determine the association between race, ethnicity and socio-economic factors with disability in IBD, using the validated IBD disability index (IBD-DI). Methods: Ambulatory IBD patients were enrolled at five academic centres participating in the New York Crohn's and Colitis Organization. We assessed the IBD-DI, and collected clinical and socio-economic data. Factors associated with moderate-to-severe disability (IBD-DI score > 35) on univariable analysis were tested in multivariable models with adjusted odds ratios (aOR) and 95% confidence intervals (CI) reported. Results: In this study, 323 patients (57.3% CD, 51.4% female) were enrolled; 17.7% were Hispanic, 17% were non-Hispanic black, 56.0% were non-Hispanic Caucasian and 9.3% belonged to non-Hispanic non-black minority races. However, 39.0% of patients were publicly insured and 38.4% of patients had low annual household income (<$50 000). 100 (31.0%) patients reported moderate-to-severe disability. On multivariable analysis, Hispanic ethnicity (aOR 2.7, 95% CI 1.3-5.6), non-Hispanic non-black minority race (aOR 3.5, 95% CI 1.3-8.9), public payer (aOR 2.1, 95% CI 1.1-4.0) and low annual household income (aOR 3.0, 95% CI 1.7-5.4) were associated with moderate-to-severe disability controlling for disease characteristics. Conclusions: IBD patients who are minorities, have public insurance, or low household income, are 2-3 times more likely to report moderate-to-severe disability independent of disease characteristics in the United States. Future studies are needed to study their complex relationship and to mitigate disability.

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