Allegheny General Hospital Pittsburgh, Pennsylvania, United States
Background Racial disparities in healthcare outcomes are well-recognized, especially in chronic conditions such as inflammatory bowel disease (IBD). When compounded with acute complications like diverticulitis, these inequities can become more pronounced. This study investigates racial differences in diverticulitis outcomes among patients with Crohn's disease (CD) and ulcerative colitis (UC), focusing on hospitalization, colectomy, and mortality rates across various racial groups. Methods We conducted a retrospective analysis of deidentified, aggregate patient data from the TriNetX research network. We analyzed 122,511 patients diagnosed with diverticulitis, identifying those with coexisting CD or UC and stratifying them by race (White, Black or African American, Hispanic, and Asian). Propensity score matching was applied to adjust for confounding factors such as age, sex, socioeconomic status, comorbidities, and lifestyle factors. Hospitalization rates were determined from the dataset, which tracked admissions related to diverticulitis, though without distinguishing specific complications. Colectomy rates (elective or emergency surgery) and mortality were also analyzed. Survival analysis was conducted using Kaplan-Meier curves, while Cox proportional hazards models were used to assess the independent effects of race on these outcomes, adjusting for relevant clinical variables. Results Significant racial disparities were observed. Black or African American UC patients had a hospitalization rate of 19.5%, compared to 13.2% in White UC patients (p< 0.001), while Black or African American CD patients had a hospitalization rate of 16.2%, compared to 11.1% in White CD patients (p< 0.001). Colectomy rates were also higher in Black or African American patients (UC: 4.1%, CD: 4.7%) compared to White patients (UC: 3.5%, CD: 4.2%, p< 0.001). Mortality rates were disproportionately higher in Black or African American patients, with 6.1% of UC patients and 5.2% of CD patients dying from their condition, compared to 4.5% and 4.1%, respectively, for White patients (p< 0.001). Kaplan-Meier survival analysis demonstrated that Black or African American patients had significantly shorter median survival times than other racial groups (p< 0.001). Conclusion Black or African American individuals have much greater rates of hospitalization, colectomy, and mortality than White patients, indicating racial differences in diverticulitis outcomes among IBD patients. Particularly for minority groups with IBD, our findings highlight the need for focused healthcare interventions and legislation to address racial disparities in diverticulitis management. Reducing these discrepancies requires implementing culturally sensitive treatment approaches and expanding access to equitable care.
