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Inflammation bowel disease I
Racial differences in use of biologics for crohn's disease in a medicaid population
  1. M Flasar1,
  2. P M Mulani2,
  3. M Yang2,
  4. J Chao *2,
  5. M Lu3,
  6. R Cross1
  1. 1University of Maryland School of Medicine, Baltimore, Maryland, USA
  2. 2Abbott Laboratories, Abbott Park, Illinois, USA
  3. 3Analysis Group, Inc., Boston, Massachusetts, USA

Abstract

Introduction Immunomodulator (IMM) and biologic (anti-TNF) use in African Americans (AA) with Crohn's disease (CD) has been reported to be lower than in white patients (W); few data exist for Hispanic patients (H). We assessed racial differences in initiation of anti-TNF agents for patients with CD using Medicaid data.

Methods Medicaid databases from Florida, Kansas and New Jersey were examined to identify all patients with CD (≥2 encounters with ICD-9 for CD) from August 1998 to March 2009. CD-related treatment (antibiotics, steroids, aminosalicylates, IMMs and anti-TNF agents), CD-related medical comorbidities, CD location, CD behaviour, surgery, and healthcare utilisation were assessed from CD diagnosis until the first anti-TNF claim or end of claims. Cox proportional-hazards model was used to assess the effect of race on odds of anti-TNF agent initiation.

Results We identified 8105 patients with CD; 7284 had race data (4602 W; 1219 AA; 663 H; 800 other). Of these, 22% W, 24% AA, 25% H and 29% of other patients were excluded owing to an ICD-9 code for ulcerative colitis, yielding a total of 5575 patients with CD (3590 W; 924 AA; 494 H; 567 other) for analysis. 18%, 17% and 17% of W, AA and H patients started IMMs after a CD diagnosis (p=not significant). 7%, 9% and 5% of W, AA and H patients initiated anti-TNF agents after a CD diagnosis (p=not significant). After adjusting for CD-related medications, comorbidities and demography, the Cox model did not reveal an association between AA patients and odds of biologic use compared with W patients (HR 1.20, 95% CI 0.93–1.54), nor between H and W patients (HR 0.68, 95% CI 0.46–1.02). To further adjust for CD severity, we analyzed patients hospitalised after CD diagnosis (n=3428). Anti-TNF treatment was initiated less often in H than W or AA patients (4% vs 8% and 7%, p=0.027 for H vs W). The Cox model showed that H patients were significantly less likely to use anti-TNF agents than W patients (HR 0.39, 95% CI 0.22–0.71). No differences between W and AA patients were found in mean doses of or time to first dose of anti-TNF agents.

Conclusion Initiation of anti-TNF agents was similar in W and AA patients but lower in H patients. Further research is needed to confirm these findings in a commercially insured population because it is possible that anti-TNF agents may be underused among all racial groups in the Medicaid population.

  • biologic therapy
  • Crohn's disease
  • race

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Footnotes

  • Competing interests M. Flasar Grant/Research Support from: Abbott, P. Mulani Shareholder with: Abbott, Employee of: Abbott, M. Yang Shareholder with: Abbott, Employee of: Abbott, J. Chao Shareholder with: Abbott, Employee of: Abbott, M. Lu Employee of: Analysis Group, under contract with Abbott, R. Cross Grant/Research Support from: Abbott, Consultant for: Abbott, Speaker bureau with: Abbott.

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