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Racial disparities exist among children with Crohn's disease
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Disparities in hospital readmissions, complications and procedures in pediatric Crohn’s disease patients are related to race, according to data from a recent retrospective review.
“We found racial inequalities exist among children and adolescents with Crohn’s disease, likely due to a combination of genetic and environmental differences,” Jennifer Dotson, MD, MPH, a gastroenterologist at Nationwide Children’s Hospital in Columbus, Ohio, and principal investigator in the Center for Innovation and Pediatric Practice, said in a press release. “This is one of the first studies to investigate the rate of various health disparities in the Crohn’s disease population in pediatrics, despite the fact that 25% of the time, Crohn’s disease is diagnosed in childhood.”
Jennifer Dotson
Using data from the Pediatric Health Information System, Dotson and colleagues compared hospitalization, medication, procedures and complications between 1,456 black and 2,921 white patients aged 21 years or younger who were admitted to a hospital for CD from 2004 to June 2012.
Black children had longer length of stay compared with white children (6.8 ± 7.1 vs. 6.3 ± 8.9 days; P < .001), and they had higher overall readmissions (1.4 ± 2.6 vs. 0.9 ± 1.9; P < .001), late readmissions (28% vs. 23%; P = .002) and readmissions after 1 year (3.1 ± 3.2 vs. 2.4 ± 2.4; P < .001). Whites had a lower probability of readmission (P = .009) and blacks had a 16% increase in risk for readmission in the first year after index admission compared with whites (P = .01). A multivariate model showed that race was a predictor of readmission (OR = 1.28; 95% CI, 1.09-1.5).
More black patients had perianal disease (8.6% vs. 5.8%; P = .011) and anemia (34.2% vs. 25.4%; P < .002) during index hospitalization, and during any hospitalization a higher percentage had perianal disease (14.6% vs. 8.3%; P < .002), anemia (42.6% vs. 31.1%; P < .002), vitamin D deficiency (2.3% vs. 0.9%; P = .002), perianal/perineal procedures (8.5% vs. 5%; P < .001), endoscopies (52.1% vs. 46.4%; P = .004) and blood product transfusions (14.2% vs. 10.9%; P = .023). Blacks also were more likely to receive biologics during any hospitalization, index hospitalization and late readmission, and they were more likely to receive corticosteroids during late readmission (all P = .001).
“Some of the differences in our study are likely attributable to intrinsic differences in disease between blacks and whites,” Dotson said. “For example, more procedures are likely a result of the increased rate of perianal disease in blacks. Other differences may reflect disparities in care, although biologic differences can’t be excluded.
“Financial barriers to outpatient care and self-management, such as transportation, medication and nutrition needs, may have impacted the outcome for these children,” she added.
Further investigation of racial and socioeconomic disparities in pediatric CD are ongoing, the release said. – by Adam Leitenberger
Disclosure: Dotson and this project were supported by the NASPGHAN Foundation/Crohn’s and Colitis Foundation of America Young Investigator Development Award. Please see the study for a full list of all other authors’ relevant financial disclosures.
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