P0713 - Introspective Racial Disparity Assessment: Timing for Biologics Initiation Among Inflammatory Bowel Disease in a Safety Net Health System

Chinonso A. Ilo, MD¹, Peter Kim, MS¹, Ashley Scholtens, MD¹, Kjersten Davis, ², Jodie Kaalekahi, FNP³, Andrew Weinberg, MD², Danlu Wang, DO², Indu Srinivasan, MD², Keng-Yu Chuang, MD^2
1Creighton University, Phoenix, AZ; ²Valleywise Health, Phoenix, AZ; ³Valleywise Health Medical Center, Phoenix, AZ

Introduction: Eliminating racial disparities in healthcare requires practitioners to acknowledge patient-associated challenges and unconscious bias based on practitioner stereotypes. One of many barriers to accessing care is insufficient insurance coverage. To effectively care for underinsured patients with inflammatory bowel disease (IBD), practitioners often need to obtain prior authorizations to prescribe biologics. In this retrospective study, we analyzed biologics initiation timing and prescription pattern among our GI providers at Valleywise Health (VW) in Phoenix, Arizona, to determine whether racial disparities existed.

Methods: All VW patients diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD) receiving biologics (infliximab, adalimumab, certolizumab, vedolizumab, ustekinumab, tofacitinib) from 2018 to 2021 were included. Demographic data (age, race, ethnicity), insurance, biologic type, date of IBD diagnosis, date of biologic initiation were collected. Uninsured patients were excluded as lack of insurance created an additional barrier to prescribing biologics. Wilcoxon rank-sum exact test was used with significance level as P < 0.05.

Results: Of the 17 CD patients,14 were non-Hispanic and 12 identified as White. Median (mean, range) duration from diagnosis to prescription was 0 (3.67, 0-11) months for Hispanics compared to 28.5 (39.64, 1 – 122) months for Non-Hispanics (P=0.224) and 13 (29, 7-98) for non-Whites compared to 27.5 (35, 0-122) for Whites (P = 0.618). Biologics prescribed: adalimumab (11), infliximab (5), and infliximab (1).



Of the 31 UC patients, 15 were Hispanic and 28 identified as White. Median (mean, range) duration from diagnosis to prescription was 19 (39.87, 0-271) months for Hispanics compared to 62.5 (39.87, 6-254) months for Non-Hispanics (P=0.0156). Analogous comparison of median (mean, range) were 47 (40.67, 7 – 68) for Non-White and 34.5 (63.7, 0-271) for Whites (P = 0.930). Biologics prescribed: vedolizumab (14), adalimumab (10), infliximab (5), ustekinumab (1), and tofacitinib (1).

Discussion: No racial disparities were observed in biologics initiation timing in our practice. In fact, Hispanic patients diagnosed with UC were started on biologics significantly earlier than non-Hispanic patients. The result could be in part a reflection of the racial and ethnic diversity among our providers. This study also suggests that as long as patients are insured, the barrier to receiving biologics is no different regardless of racial or ethnicity.



Disclosures:


Chinonso A. Ilo, MD¹, Peter Kim, MS¹, Ashley Scholtens, MD¹, Kjersten Davis, ², Jodie Kaalekahi, FNP³, Andrew Weinberg, MD², Danlu Wang, DO², Indu Srinivasan, MD², Keng-Yu Chuang, MD². P0713 - Introspective Racial Disparity Assessment: Timing for Biologics Initiation Among Inflammatory Bowel Disease in a Safety Net Health System, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.