Epidemiology and Clinical Outcomes of Hospitalized Hispanic Patients With IBD: Results of a Large National Cohort Study

Introduction: Inflammatory bowel disease (IBD) has historically been seen as predominantly affecting non-Hispanic Whites (NHW). The present understanding of the epidemiology of IBD within the United States (US) has been based on studies consisting of primarily NHW patients with minimal ethnoracial diversity. Hispanics are the largest minority group in the US, yet they remain grossly underrepresented in studies of IBD. With this study, we aimed to better understand the epidemiology, demographics, clinical outcomes, treatment and hospitalization costs of Hispanic patients with IBD in the US. Methods: This was a retrospective cohort study utilizing the National Inpatient Sample (NIS), the largest publicly available all-payer inpatient care database in the US. We compared demographics, hospitalization characteristics, clinical outcomes, and year-to-year trends from 2016 to 2020 in Hispanic and NHW with a primary diagnosis of IBD, Crohn’s disease (CD) or ulcerative colitis (UC). Statistical analyses included 2-proportion t-test, analysis of variance, binomial proportion confidence interval, general linear model and logistic regression. Results: While NHW with a primary diagnosis of IBD had significantly higher rates of hospitalization (122.67 vs 71.12, P< 0.01) compared to Hispanics, the rate of Hispanics hospitalized with IBD annually is significantly increasing relative to NHW (P=0.03). Hispanics are more likely to be in the lowest quartile for household income (31.6% vs 19.3%, P< 0.01), have a younger median age (37.0 vs 45.0, P< 0.01), and be uninsured (4.3% vs 8.8%, P< 0.01) compared to NHW. NHW had higher rates of small bowel surgery among CD patients (2.4% vs 1.6%, P< 0.01) and total colectomy among UC patients (4.1% vs 2.4%, P< 0.01). While length of admission and rates of ICU admission were similar, NHW patients with IBD had higher rates of mortality (0.3% vs 0.2%, P=0.01). However, total charges for hospitalizations were significantly higher for Hispanic patients with IBD (P< 0.01) and charges for Hispanics are increasing at a significantly greater rate relative to NHW annually (P< 0.01) (Table 1). Conclusion: To our knowledge, this is the largest US-based study of Hispanics with IBD. Our findings suggest that among hospitalized IBD patients, Hispanics are more likely to be younger, uninsured, have a lower household income, and less likely to undergo surgery, while having higher costs and rising rates of hospitalizations. Table 1. - Demographics of Inflammatory Bowel Disease Hospitalizations for NIS Database 2016-2020 Inflammatory Bowel Disease Crohn’s Disease Ulcerative Colitis White Hispanics P-value White Hispanics P-value White Hispanics P-value Total Hospitalizations 133305 15055 < 0.01 87330 7225 < 0.01 45975 7830 < 0.01 Rate per 100,000 NIS hospitalizations 122.67 71.12 < 0.01 80.36 34.13 < 0.01 42.31 36.99 0.03 Gender (%Female) 70640 (53.0%) 7660 (50.9%) < 0.01 45595 (52.2%) 3565 (49.3%) < 0.01 25045 (54.5%) 4095 (52.3%) 0.02 Age in years, median 45.0 37.0 < 0.01 44.0 37.0 < 0.01 48.0 37.0 < 0.01 Age group (years) 0-17 7315 (5.5%) 1575 (10.5%) < 0.01 3925 (4.5%) 680 (9.4%) < 0.01 3390 (7.4%) 895 (11.4%) < 0.01 18-64 97810 (73.4%) 11155 (74.1%) 0.06 67045 (76.8%) 5570 (77.1%) 0.53 30765 (66.9%) 5585 (71.3%) < 0.01 >= 65 28180 (21.1%) 2325 (15.4%) < 0.01 16360 (18.7%) 975 (13.5%) < 0.01 11820 (25.7%) 1350 (17.2%) < 0.01 Median household income 1st quartile (lowest) 25355 (19.3%) 4665 (31.6%) < 0.01 16690 (19.4%) 2135 (30.0%) < 0.01 8665 (19.1%) 2530 (32.9%) < 0.01 2nd quartile 34245 (26.0%) 3770 (25.5%) 0.08 22295 (25.9%) 1870 (26.3%) 0.52 11950 (26.4%) 1900 (24.7%) 0.01 3rd quartile 36110 (27.5%) 3740 (25.3%) < 0.01 23915 (27.7%) 1790 (25.2%) < 0.01 12195 (26.9%) 1950 (25.4%) 0.02 4th quartile (highest) 35800 (27.2%) 2610 (17.7%) < 0.01 23310 (27.0%) 1310 (18.4%) < 0.01 12490 (27.6%) 1300 (16.9%) < 0.01 Insurance type (%) Medicare 35275 (27.3%) 2690 (18.7%) < 0.01 22015 (26.0%) 1220 (17.6%) < 0.01 13260 (29.8%) 1470 (19.7%) < 0.01 Medicaid 18390 (14.2%) 4700 (32.7%) < 0.01 12400 (14.7%) 2050 (29.6%) < 0.01 5990 (13.5%) 2650 (35.5%) < 0.01 Private 69820 (54.1%) 5715 (39.8%) < 0.01 46710 (55.2%) 3075 (44.4%) < 0.01 23110 (52.0%) 2640 (35.4%) < 0.01 Uninsured 5590 (4.3%) 1270 (8.8%) < 0.01 3490 (4.1%) 575 (8.3%) < 0.01 2100 (4.7%) 695 (9.3%) < 0.01 Steroid use 10450 (7.8%) 985 (6.5%) < 0.01 6480 (7.4%) 430 (6.0%) < 0.01 3970 (8.6%) 555 (7.1%) < 0.01 Small bowel surgery 2150 (1.6%) 115 (0.8%) < 0.01 2110 (2.4%) 115 (1.6%) < 0.01 40 (0.1%) 0 (0.0%) 0.01 Partial colectomy 6485 (4.9%) 360 (2.4%) < 0.01 5570 (6.4%) 245 (3.4%) < 0.01 915 (2.0%) 115 (1.5%) < 0.01 Total colectomy 1915 (1.4%) 190 (1.3%) 0.33 35 (< 1%) 0 (0.0%) 0.09 1880 (4.1%) 190 (2.4%) < 0.01 Rectal surgery 3085 (2.3%) 265 (1.8%) < 0.01 425 (0.5%) 15 (0.2%) < 0.01 2660 (5.8%) 250 (3.2%) < 0.01 ICU admission 370 (0.3%) 40 (0.3%) 0.91 210 (0.2%) 20 (0.3%) 0.55 160 (0.3%) 20 (0.3%) 0.21 Length of stay, median (days) 3.0 3.0 0.86 3.0 3.0 0.94 4.0 4.0 0.84 Died during hospitalization 375 (0.3%) 25 (0.2%) 0.01 UTR UTR NA 220 (0.5%) 20 (0.3%) 0.01 Total charges, median (dollars) 30548.0 37417.0 < 0.01 28616.0 34390.5 < 0.01 34095.0 40869.0 < 0.01 NIS, National Inpatient Sample, NHW, Non-Hispanic White; UTR, Unable To Report (as per National Inpatient Sample guidelines when number is greater than 0 but less than 10); NA, not applicable.