Black Patients With Ulcerative Colitis Less Likely to Undergo IPAA Than White Patients

Approximately 15% to 20% of individuals diagnosed with ulcerative colitis (UC) are expected to undergo surgery at some point in their lives, with ileal pouch–anal anastomosis (IPAA) being the favored surgical choice. However, recent findings published in Crohn's & Colitis 360 have highlighted disparities based on race and ethnicity in the rates of surgery, particularly evident between Black and White patients.

Ulcerative colitis | Image credit: eddows – stock.adobe.com

Employing the National Inpatient Sample (NIS) dataset from 2009 to 2018, the observational retrospective study encompassed all US patients with UC identified by ICD-9/10CM codes. The primary focus was on analyzing trends in IPAA construction among different races and ethnicities over the past decade, with White patients serving as the reference group. Multivariate regression analyses were applied to account for variables such as age, gender, Charlson comorbidity index, income in patient zip code, insurance status, hospital region, location, size, and teaching status.

Overall, there were more than 1.1 million hospital admissions related to UC overall, with 60,688 individuals requiring surgery for UC, and only 16,601 undergoing IPAA specifically.

The number of patients discharged from US hospitals with a UC diagnosis increased between 2009 (n = 107,649) and 2018 (n = 127,665). However, during the same period, there was a decline in the number of patients opting for IPAA, going from 2225 in 2009, down to 1285 in 2018 (2.07% vs 1.01%, P = .0099). This was reflected by a decrease from 2067 IPAAs per 100, 000 patients in 2009, to 1007 per 100,000 in 2018.

“This could be explained by the increasing incidence of IBD [inflammatory bowel diseases] in recent years and more IBD awareness among general physicians,” the researchers noted. “However, our study shows that the total percentage of patients with UC undergoing IPAA in 2018 was significantly less compared to 2009 and this is likely because of the more available and widespread use of advanced therapies in recent years.”

The researchers also found that, while IPAAs were overall more frequently performed in large hospitals, the proportion of IPAA procedures increased by 10% between 2009 and 2018.

Most notably, the study found that Black patients, which made up 4.7% of the patients undergoing surgery in general, were less likely to choose IPAA compared with White patients in both 2009 (OR, 0.38l 95% CI, 0.20-0.74; P < .01) and 2018 (OR, 0.50; 0.29-0.85; P = .01). Additionally, in 2009, Hispanic patients were significantly less inclined to undergo IPAA, though this disparity was no longer observed in 2018 compared with their White counterparts.

The study indicated no statistically significant disparities in the mortality and severe morbidity rates following IPAA across various racial and ethnic groups in both 2009 and 2018. This finding aligns with other research, affirming the absence of differences in complication rates and outcomes after IPAA among Black, Hispanic, and White patients.

“However, our data contrast with other studies that showed that composite postoperative morbidity after elective surgeries for IBD was highest for Black patients and that non-White patients had increased odds of individual complications after surgery for IBD,” the researchers added. “It is important to point out that those studies did not specifically evaluate IPAA surgery. Also, among patients with UC undergoing total proctocolectomy with IPAA, Hispanic and Black patients were significantly more likely to require readmission within 30 days of surgery than White patients.”

Additional research is necessary to enhance comprehension of the reasons behind these racial disparities, and should explore the specific factors influencing the rates of IPAA surgery among diverse racial and ethnic groups, taking into account variables such as disease severity, patient preferences, and the types of medications administered before undergoing IPAA.

Reference

Hashash JG, Mourad FH, Odah T, Farraye FA, Kroner P, Stocchi L. Ethnic variation trends in the use of ileal pouch-anal anastomosis in patients with ulcerative colitis. Crohns Colitis 360. Published online November 16, 2023. doi:10.1093/crocol/otad072