Survey results suggest Black patients face greater barriers to IBD treatment
SAN DIEGO — Black patients with inflammatory bowel disease were more likely to use older therapies and face continued barriers to effective care, according to survey results presented at Digestive Disease Week 2022.
“We need to provide education to all patients with IBD and engage each patient in shared decision-making,” Adjoa Anyane-Yeboa, MD, a gastroenterologist at Massachusetts General Hospital and Harvard Medical School, told Healio. “We determined that Black patients in our study wanted more information about the risks and benefits of medications and more engagement in the discussion around various treatments. This work has actually sparked a future project geared towards tailoring shared decision-making resources for Black patients with IBD that will help providers caring for diverse IBD patients.”
To better understand racial disparities in care, PRIME Education developed a survey, which was reviewed by an IBD specialist and administered to patients at two community-based gastroenterology practices between August and October 2021. A total of 87 patients with Crohn’s disease (55%) or ulcerative colitis (44%) responded, of whom 54% self-identified as non-Hispanic white and 46% identified as Black. A majority (66%) were women.
Anyane-Yeboa and colleagues noted similarities among Black and white patients with respect to age, sex, IBD type, insurance and self-reported disease activity, and all patients who responded had health insurance, of whom 95% were privately insured.
According to survey results, the most frequently reported IBD therapy was TNF-inhibitors (TNFi), with more Black patients reporting TNFi use than white patients (67% vs. 43%, P < .05). However, more white patients reported use of newer anti-integrin therapies (29% vs. 13%, P < .05).
In addition, although not statistically significant, more white patients reported using newer IL-12/23 inhibitors compared with Black patients (15% vs. 5%) and also reported trying more IBD therapies, with 60% of white patients having tried four or more different treatments compared with 15% of Black patients.
Further, compared with white patients, more Black patients reported IBD “greatly affects” their lives (18% vs. 4%) and felt “slightly or moderately confident” in understanding their treatment plans (31% vs. 15%). Fewer Black patients also reported being involved in their treatment decisions as much as they would have liked (85% vs 96%) and more Black patients reported their care team should provide more IBD education (26% vs. 12%).
The primary concern regarding IBD treatment was “lack of insurance approval” among 13% of Black patients compared with 0% of white patients.
“Additional studies are needed to determine the influence of factors such as implicit bias, social determinants of health and structural racism on disparities in IBD,” Anyane-Yeboa and colleagues wrote.
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Anyane-Yeboa A, et al. Abstract 469. Presented at: Digestive Disease Week; May 21-24, 2022; San Diego (hybrid meeting).