Crohn’s disease is increasing in the Black community, and systemic healthcare disparities, not just biology, are the cause. Those in our community who are diagnosed, are more likely to experience complications, more severe disease outcomes and higher rates of hospitalization. They are also less likely to receive or be prescribed advanced therapies and treatments, while being more likely to rely on emergency care instead of regular treatment over time.
According to a study published in Annals of Gastroenterology , “Between 1970 and 2010, [Chronic Inflammatory Bowel Disease, or] IBD incidence increased by 39% in White patients, but by 134% in minority populations.”
It is beginning to be understood that the impact of IBD, Crohn’s disease and Ulcerative Colitis, on diverse racial and ethnic populations is increasing, with these minority groups experiencing more severe disease outcomes due to disparities in access to healthcare. “Black patients with [Ulcerative colitis or] UC, for example, are less likely to be under the care of a gastroenterologist and more likely to experience emergency department visits and delayed colectomy.”
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What is IBD?
The US Center for Disease Control and Prevention, or CDC, explains that IBD is an umbrella term for “a group of lifelong diseases affecting the intestines. IBD occurs when the body’s natural defense system mistakenly attacks healthy bowel cells. This causes inflammation (swelling) and other damage that does not go away on its own.” There are two main types of IBD, Crohn’s disease and Ulcerative colitis.
The growing understanding that disparities in access to healthcare are playing such a major role in the disease outcome of minority populations when it comes to forms of IBD like Crohn’s disease, is showing that it is necessary to understand disease trends and characteristics among varied racial and ethnic groups. These differences could directly when and how we are diagnosed and treated.
Crohn’s Disease and the Difference in Impact on the Black Community
Studies are finding that we are experiencing Crohn’s disease and its symptoms in different places in their body compared to other racial and ethnic groups. For example, the same study published by Annals of Gastroenterology shows that, among patients with Crohn’s disease, Black patients had the highest prevalence of anal abscess, followed by Asian, Hispanic, and White people. Similarly, rectal bleeding was more common in Black patients than in White patients.
“Racial disparities exist in complications associated with IBD. Black and Hispanic patients had higher odds of perianal complications, while White patients had more intestinal obstruction. These findings emphasize the need for earlier intervention and improved access to advanced therapies in diverse populations.”
Patient Outcomes and Why these Differences Exist
In an article published in Gastroenterology & Hepatology, Racial and Ethnic Disparities in Inflammatory Bowel Disease, Marie L Borum, MD, EdD, MPH addressed delayed IBD diagnosis Black and Hispanic patients, “Historically, it was taught that Black and Hispanic individuals are not at risk of developing IBD. When IBD is not considered to be a disease that can occur in these individuals, they may not receive appropriate diagnostic testing for symptoms that would prompt an evaluation for IBD in White patients, leading to a delay in diagnosis or misdiagnosis.”
“Access to care may also result in delayed diagnosis and progression of disease severity. Social determinants of health and the ability to access care continue to be concerns for all patients. The intersection of socioeconomic issues, access to care, and IBD awareness may affect an individual’s ability to advocate for an evaluation. However, racial and ethnic minorities who have access to care may experience a delay in IBD diagnosis if there is a lack of awareness of increasing IBD prevalence.”
Racial bias and lowered socio-economic status are directly impacting if and/or when we get a proper diagnosis and this can have serious consequences. Receiving care at later stages of Crohn’s disease can lead to worsened outcomes like:
- Strictures (bowel scarring) and fistulas (links between organs that shouldn’t be there)
- Bowel cancer
- More trips to the emergency department
- Higher rates of hospitalization
Preventing Worsened Disease Outcomes: What to Do
The first line of defense in combating these unfortunate truths is for us to become better educated and understanding around IBD and Crohn’s disease in our community. Because racial bias and socioeconomics play such a critical role in disease outcome and in access to healthcare for Black patients, much of the work to change this fall on the community.
It is critical that we learn the symptoms of IBD and Crohn’s disease and become advocates in the presence of healthcare providers, for ourselves and our loved ones. It is important that they share what they know about this disease with friends and family and begin to put the pieces together around the symptoms they may be experiencing and how to get a proper diagnosis sooner.
