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Despite Rising Cases Hispanic Americans Face Delays in IBD Treatment
Crohn’s disease and ulcerative colitis are still largely thought of as white diseases. Experts say that needs to change to adequately care for all people. By Kaitlin SullivanSeptember 8, 2022Fact-CheckedProvider education is as important as patient education when it comes to diagnosing and treating IBD.Bongkarn Thanyakij/iStockCases of inflammatory bowel disease (IBD) have increased in all races in the United States over the past two decades, according to Centers for Disease Control and Prevention (CDC) data. But the disease — which includes both Crohn’s Disease and ulcerative colitis (UC) — is still largely misdiagnosed in Hispanic Americans. A review published in July 2022 in the journal Inflammatory Bowel Diseases outlined the disparities in IBD treatment and diagnosis among Black and Hispanic Americans that was previously discussed at a meeting held in December 2021 at Morehouse School of Medicine, in Atlanta. According to Julia Liu, MD, chief of the division of gastroenterology at Morehouse School of Medicine in Atlanta, who coauthored the paper, equitable patient care starts with recognizing IBD as a disease that can impact anyone. Dr. Liu says IBD has been traditionally thought of as a disease that mostly affects white people, particularly Ashkenazi Jews. Although IBD is still most prevalent in these populations, the disease can affect everyone, including Hispanic Americans, and is increasingly doing so. “It’s important for healthcare providers to recognize that,” she says. A study published in January 2021 in the International Journal of Colorectal Disease evaluated cases of IBD in Hispanic Americans and white Americans in the Los Angeles area. They found that the incidence rate of IBD between the two groups was not as different as previously thought. The prevalence of IBD among Hispanic Americans in the study was 418 per 100,000 people, compared with 557 per 100,000 people in white Americans. Hispanic Americans who had IBD were also much less likely to smoke compared with white Americans. Editor' s Picks
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A failure to recognize IBD as a disease that can affect anyone creates serious consequences for nonwhite patients. “When you see someone who is white, especially if they are of Jewish descent, you immediately think IBD,” Liu says. “But if you see a nonwhite person with the same symptoms, you may think it’s something else, like irritable bowel syndrome.” For this reason, Hispanic patients tend to be subject to delays in diagnosis, and therefore treatment, for IBD. According to Miguel Regueiro, MD, chair of the Digestive Disease and Surgery Institute at Cleveland Clinic in Ohio, who was not involved in the 2022 paper, delayed treatment in people with IBD can cause complications that make the disease more difficult to get under control. And while clinical trials have investigated genetic variations in Black Americans that could make certain people more susceptible to IBD, as well as how the disease presents differently in this population, very little is known about how IBD may be different in Hispanic patients. Compared with white patients, Hispanic and nonwhite patients appear to more commonly have IBD that causes scattered ulcers in the colon and more colonic disease than small bowel disease, says Dr. Regueiro. What is still unclear is whether or not there are differences in nongastrointestinal symptoms, including skin and eye problems and joint pain. Hispanic patients also typically receive less aggressive treatment once they are diagnosed with IBD, says Regueiro. “Some of it could be delays in presentation,” he says, noting that it may also have to do with socioeconomic status. “Some of these advanced therapies are more expensive, whereas steroids are relatively cheap, certain medications may be used in patients based on their ability to pay for medication.” The review did not come to a conclusion about this, but it may be a factor, he notes. Systemic racism and distrust in the medical system may also play a role. “Patients may be apprehensive to go on biologics or other therapies because they are concerned about cost or side effects. That could lead to an overuse of steroids that may not be effective, but which are based on the patient's comfort level,” says Regueiro, adding that ensuring there is not a language barrier is also key. If a patient has concerns and needs to think about it, having other healthcare providers — such as pharmacists who can conduct follow up visits or phone calls — can help educate as part of the team of healthcare providers that can ensure equal access to care. “The main message is that patients need to be a bit more aware of these symptoms not just for them and try to seek medical care, but provider education is important, too. By the time they go to see the provider, it’s no help if the physician doesn’t have knowledge,” Regueiro says. NEWSLETTERS Sign up for our Living With IBD Newsletter
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