Race Differences in Initial Presentation, Early Treatment, and 1-year Outcomes of Pediatric Crohn's Disease

Results from the ImproveCareNow Network

Jennifer L. Dotson, Michele Cho, Josh Bricker, Michael D. Kappelman, Deena J. Chisolm, Gitit Tomer, Wallace V. Crandall

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Racially disparate care has been shown to contribute to suboptimal health care outcomes for minorities. Using the ImproveCareNow network, we investigated differences in management and outcomes of pediatric patients with Crohn's disease at diagnosis and 1-year postdiagnosis. Methods: ImproveCareNow is a learning health network for pediatric inflammatory bowel disease. It contains prospective, longitudinal data from outpatient encounters. This retrospective study included all patients with Crohn's disease ≤21 years, September 2006 to October 2014, with the first recorded encounter ≤90 days from date of diagnosis and an encounter 1 year ±60 days. We examined the effect of race on remission rate and treatment at diagnosis and 1 year from diagnosis using t-tests, Wilcoxon rank-sum tests, χ 2 statistic, and Fisher's exact tests, where appropriate, followed by univariate regression models. Results: Nine hundred seventy-six patients (Black = 118 (12%), White = 858 (88%), mean age = 13 years, 63% male) from 39 sites were included. Black children had a higher percentage of Medicaid insurance (44% versus 11%, P < 0.001). At diagnosis, Black children had more active disease according to physician global assessment (P = 0.027), but not by short Pediatric Crohn's Disease Activity Index (P = 0.67). Race differences in treatment were not identified. Black children had lower hematocrit (34.8 versus 36.7, P < 0.001) and albumin levels (3.6 versus 3.9, P = 0.001). At 1 year, Black children had more active disease according to physician global assessment (P = 0.016), but not by short Pediatric Crohn's Disease Activity Index (P = 0.06). Conclusions: Black children with Crohn's disease may have more severe disease than White children based on physician global assessment. Neither disease phenotype differences at diagnosis nor treatment differences at 1-year follow-up were identified.

Original languageEnglish (US)
Pages (from-to)767-774
Number of pages8
JournalInflammatory Bowel Diseases
Volume23
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Crohn Disease
Nonparametric Statistics
Physicians
Therapeutics
Pediatrics
Medicaid
Insurance
Inflammatory Bowel Diseases
Hematocrit
Pediatric Crohn's disease
Albumins
Outpatients
Retrospective Studies
Learning
Delivery of Health Care
Phenotype
Health

Keywords

  • Crohn's disease
  • disparities
  • inflammatory bowel disease
  • pediatric
  • race

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

Cite this

Race Differences in Initial Presentation, Early Treatment, and 1-year Outcomes of Pediatric Crohn's Disease : Results from the ImproveCareNow Network. / Dotson, Jennifer L.; Cho, Michele; Bricker, Josh; Kappelman, Michael D.; Chisolm, Deena J.; Tomer, Gitit; Crandall, Wallace V.

In: Inflammatory Bowel Diseases, Vol. 23, No. 5, 01.05.2017, p. 767-774.

Research output: Contribution to journalArticle

Dotson, Jennifer L. ; Cho, Michele ; Bricker, Josh ; Kappelman, Michael D. ; Chisolm, Deena J. ; Tomer, Gitit ; Crandall, Wallace V. / Race Differences in Initial Presentation, Early Treatment, and 1-year Outcomes of Pediatric Crohn's Disease : Results from the ImproveCareNow Network. In: Inflammatory Bowel Diseases. 2017 ; Vol. 23, No. 5. pp. 767-774.
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