Systematic review: The role of race and socioeconomic factors on IBD healthcare delivery and effectiveness

Authors

  • Justin L. Sewell MD, MPH,

    1. Center for Innovation in Access and Quality, Division of Gastroenterology and Hepatology, San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, California
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  • Fernando S. Velayos MD, MPH

    Corresponding author
    1. Center for Crohn's and Colitis, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California
    • Center for Crohn's and Colitis, Division of Gastroenterology, 2330 Post St., Room 610, Box 1623, San Francisco, CA 94143
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  • Supported in part by a training grant from the National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK007007-35), National Institutes of Health (to J.S.). FV was supported by the National Center for Research Resources, the National Center for Advancing Translational Sciences, and the Office of the Director, National Institutes of Health, through UCSF-CTSI Grant Number KL2 RR024130. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Abstract

Background:

Race and socioeconomic status (SES) significantly affect the content and delivery of healthcare for multiple chronic disease states. Inflammatory bowel disease (IBD) is a set of complex, chronic diseases with the potential for significant morbidity if the content or delivery of healthcare is suboptimal. However, the literature related to race, SES, and IBD remains fragmented.

Methods:

Using guidelines published by the Centre for Reviews and Dissemination, we performed a systematic review of the world's literature to identify studies related to: 1) IBD, 2) race/ethnicity, 3) SES, 4) healthcare delivery, and 5) healthcare effectiveness.

Results:

We identified 40 studies that met inclusion criteria. Twenty-four studies (60%) assessed the role of SES and 21 (53%) evaluated race. Topics addressed by these studies included: 1) Utilization of Medical and Surgical Therapy; 2) Adherence to Medical Therapy; 3) Clinical Outcomes; 4) Healthcare Access and Utilization; 5) Disease Perception and Knowledge; and 6) Employment/Insurance. We identified race- and SES-based disparities in the content of medical and surgical healthcare, utilization of inpatient and ambulatory medical care, adherence to medical therapy, and disease perceptions and knowledge. Several studies also identified race- and SES-based disparities in outcomes for IBD, including in-hospital mortality rates and health-related quality of life.

Conclusions:

Race- and SES-based disparities in the delivery and effectiveness of healthcare for patients with IBD exist in numerous domains, yet studies remain limited in their scope and breadth. Concerted, prospective, multicenter efforts are needed to address underlying causes for disparities and to identify methods of reducing and eliminating disparities. (Inflamm Bowel Dis 2012;)

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