In a new review entitled “Racial Disparities in Readmission, Complications, and Procedures in Children with Crohn’s Disease” authors describe ethnicity-based decisions in hospital care of children affected by Crohn’s disease. The review was published in the journal Inflammatory Bowel Diseases.
The authors retrieved data from the Pediatric Health Information System, a large pediatric database of clinical data (laboratory, microbiology and radiology results) to determine how racial disparities impact Crohn’s disease care and outcome in pediatric patients. The data was collected from patients younger than 21 years old who were hospitalized and diagnosed with Crohn’s disease, and included 4,377 patients. The selection included white and black patients, randomly selected. The study determined, as its primary outcome, the time elapsed between hospital discharge and readmission, and as secondary outcomes the team assessed the rate of frequency in complications and hospital procedures.
The authors found that when comparing black and white children, the former experienced a shorter wait period to be readmitted for the first time to hospital care, as well as a 16% increase in the risk for posterior readmissions, when compared to white children. Moreover, the team found that black children stayed for longer periods and with higher frequencies in hospital care. In terms of disease outcomes during hospitalizations, black children exhibited higher rates of perianal disease, anemia and vitamin D deficiency, and were more frequently submitted to perianal procedures, endoscopies and blood transfusions. Additionally, black children received with higher frequency treatments with biologics and steroids, when compared to white children.
The authors are now engaged in understanding the reasons between the disparities found in this initial study.
Jennifer Dotson, MD, MPH, a gastroenterologist at Nationwide Children’s Hospital in Columbus, Ohio, and study first author commented in a press release, “We found racial inequalities exist among children and adolescents with Crohn’s disease, likely due to a combination of genetic and environmental differences. 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. Some of the differences in our study are likely attributable to intrinsic differences in disease between blacks and whites. 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.”
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