Disparities in the use of immunomodulators and biologics for the treatment of inflammatory bowel disease: A retrospective cohort study
Disparities in the use of immunomodulators and biologics for the treatment of inflammatory bowel disease: A retrospective cohort study
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DOI：
10.1002/ibd.20298
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发表时间：
2008-01-01
影响因子：
4.9
通讯作者：
Cross, Raymond K.
中科院分区：
文献类型：
--
作者：
Flasar, Mark H.;Johnson, Tamara;Cross, Raymond K.
背景：非裔美国人（AA）和高加索人之间的治疗差异存在于多种疾病。炎症性肠病（IBD）的研究有限。我们的目的是评估AA和高加索人在治疗上的差异，控制疾病的严重程度。研究方法：我们确定了1997-2005年在马里兰州大学和巴尔的摩退伍军人事务医疗中心评估的溃疡性结肠炎（UC）或克罗恩病（CD）门诊患者。我们按种族评估了使用的药物和协变量的存在。结果：我们确定了406例患者; 102例为AA（25%）。AA接受类固醇（56% vs 68%; P = 0.02）、巯基嘌呤/硫唑嘌呤（6-MP/AZA）（28% vs 40%; P = 0.03）、英夫利昔单抗（IFX）（10% vs 20%; P = 0.03）或6-MP/AZA或IFX（28% vs 44%; P = 0.005）的可能性较小。诊断时年龄< 40岁（比值比[OR] 2.22，95%置信区间[CI] 1.06-4.54），类固醇使用（OR 4.75，95% CI 1.93-11.7）和CD（OR 6.25，95% CI 3.22-12.5）与IFX使用呈正相关，而AA（OR 0.50，95% CI 0.23-1.08）与IFX使用呈负相关。诊断时年龄< 40岁（OR 1.84，95% CI 1.12-3.23），类固醇使用（OR 10.2，95%CI 5.37-19.2），CD（OR 2.32，95%CI 1.43-3.20）与6-MP/AZA或IFX使用呈正相关，而AA（OR 0.57，95% CI 0.32-1.01）与6-MP/AZA或IFX使用呈负相关。结论：与白人相比，AA患者接受IFX或6-MP/AZA或IFX治疗的几率有降低的趋势。需要进一步的研究来确定这些差异是否是由于AA患者的疾病不太严重或由于护理的差异。
Background: Treatment disparities between African Americans (AA) and Caucasians exist in multiple diseases. There are limited studies in inflammatory bowel disease (IBD). Our objectives were to assess differences in 1131) therapies between AA and Caucasians, controlling for disease severity. Methods: We identified outpatients with ulcerative colitis (UC) or Crohn's disease (CD) evaluated at the University of Maryland and the Baltimore Veterans Affairs Medical Center from 1997-2005. We assessed medications used and the presence of covariates by race. Results: We identified 406 patients; 102 were AA (25%). AA were less likely to receive steroids (56% versus 68%; P = 0.02), mercaptopurine/azathioprine (6-MP/AZA) (28% versus 40%; P = 0.03), infliximab (IFX) (10% versus 20%; P = 0.03), or either 6-MP/AZA or IFX (28% versus 44%; P = 0.005). Age at diagnosis < 40 (odds ratio [OR] 2.22, 95% confidence interval [CI] 1.06-4.54), steroid use (OR 4.75, 95% Cl 1.93-11.7), and CD (OR 6.25, 95% CI 3.22-12.5) were positively associated with IFX use, while AA (OR 0.50, 95% CI 0.23-1.08) was negatively associated with IFX use. Age at diagnosis < 40 (OR 1.84, 95% CI 1.12-3.23), steroid use (OR 10.2,95% CI 5.37-19.2), and CD (OR 2.32,95% CI 1.43-3.20) were positively associated with either 6-MP/AZA or IFX use, while AA (OR 0.57, 95% CI 0.32-1.01) was negatively associated with 6-MP/AZA or IFX use. Conclusions: There were trends toward lower odds of treatment with IFX or either 6-MP/AZA or IFX in AA when compared with Caucasians. Further studies are needed to determine if these differences are due to less severe disease in AA patients or due to disparities in care.