Barriers to Inflammatory Bowel Disease Care in a Majority Hispanic Population: A Patient Survey

Background:
Data on access to inflammatory bowel disease (IBD) care and patient outcomes in diverse populations, particularly Hispanics, is limited. Previous studies suggest that lower access to IBD specialists in Black, Indigenous, People of Color, and Hispanic (BIPOC/H) may lead to worse outcomes. This study evaluates care barriers, disease status, health-related quality of life (HRQOL), medication attitudes, and health care resource utilization (HCRU) in diverse patients with IBD inclusive of a large Hispanic population treated at a large academic and safety-net hospital in Los Angeles County.
Methods:
An anonymous survey was administered with input from a diverse panel of patients with IBD between March and August 2024 Collected were demographics, symptoms, care access via the Consumer Assessment of Healthcare Providers and Systems and Barriers to Care surveys, HRQOL via the Short Inflammatory Bowel Disease Questionnaire, HCRU including emergency department (ED) and inpatient admissions, the Beliefs about Medicines Questionnaire and the Medication Adherence Rating Scale-4. Analyses compared BIPOC/H and White/non-Hispanic (W/NH) patients via X2 and t-tests.
Results:
Surveyed to date were 138 patients: 56% Hispanic, 10% Black, 7% Asian, 4% multi-racial, and 23% W/NH. Females represented 56%; the mean [SD] age was 41 [14] years; 20% were underinsured. BIPOC/H patients reported poorer disease control compared to W/NH (26% vs 10%; <italic>P &#x3d;</italic> .049) and lower mean [SD] HRQOL scores (4.6 [1] vs 5.0 [1]; p&#x3d;.045). In the previous 12 months, 35% of the total had experienced an ED visit with a trend towards more HCRU by BIPOC/H patients vs W/NH (39% vs 20%; p&#x3d;.05); 41% of BIPOC/H and 24% of W/NH patients had required an inpatient admission (p&#x3e;.05). Regardless of race and ethnicity, 20% reported difficulty accessing an IBD specialist, 27% reported having significant delays accessing any IBD care, and 20% reported difficulty accessing IBD medication. Of the total, 42% reported difficulty working or attending school due to IBD symptoms, and 30% reported financial difficulty due to the cost of their IBD care. Lack of social and emotional support for IBD was reported by 37%, with no differences between racial and ethnic subgroups. BIPOC/H vs W/NH patients reported their IBD medications were more likely to disrupt their lives compared to W/NH (35% vs 13%; p&#x3d;.047, respectively); were more likely to worry about being dependent upon medication (69% vs 29%; p &#x3c; .001, respectively); and were more concerned about their medications being addictive (22% vs 3%; p &#x3c; .001, respectively). There were no differences in medication adherence.
Conclusions:
In this diverse population of patients with IBD including a large proportion of Hispanics, BIPOC/H patients had worse clinical disease, lower HRQOL scores, and more concerns about IBD medications. The entire population reported challenges accessing specialists and receiving care in a timely manner, high rates of HCRU, and limited social and emotional support. Future programs to understand and address the differences in their care and outcomes are needed.