Disparities in Outcomes for Patients With Inflammatory Bowel Disease at a Private vs Public Hospital in New York City.

Abstract

BACKGROUND: In patients with inflammatory bowel disease (IBD), social determinants of health contribute to health inequalities. We aimed to compare patients with IBD treated at a private nonprofit vs public hospital in New York City. METHODS: We performed a retrospective study of adult patients with Crohn's disease or ulcerative colitis with established IBD care. Patient demographics, disease characteristics, healthcare utilization, treatment modalities, and clinical outcomes were collected. Using a series of linear mixed and logistic models, the differences between care at a private nonprofit vs public hospital were assessed while controlling for factors that differed between them. RESULTS: Our study included 418 patients with IBD, 209 from each hospital. Compared with public hospital patients, private hospital patients were more likely to be White, be non-Hispanic, and have private insurance (all P&#x2009;=&#x2009;.0005) and less likely to face housing instability (P&#x2009;<&#x2009;.0001), face unemployment (P&#x2009;=&#x2009;.0004), be current smokers (P&#x2009;=&#x2009;.03), or be foreign born (P&#x2009;<&#x2009;.0001). Patients at the private hospital were more likely to have multiple anti-tumor necrosis factor (P&#x2009;=&#x2009;.0001) and biologic use (P&#x2009;<&#x2009;.0001). Public hospital patients were less likely to be considered endoscopically adherent (odds ratio [OR], 0.377; P&#x2009;=&#x2009;.001) and more likely to visit the emergency department (OR, 5.01; P&#x2009;<&#x2009;.0001) and be hospitalized (OR, 1.92; P&#x2009;=&#x2009;.05). CONCLUSIONS: Our study is the first to identify significant differences in patient demographics, disease phenotype, treatments and clinical outcomes between patients treated for IBD at a private nonprofit vs public hospital. Our data suggest that social determinants of health drive disparities in the utilization of healthcare facilities.