Racial, Ethnic, and Geographic Disparities in Immunization Rates Among Patients With Inflammatory Bowel Disease

Poonam Beniwal-Patel; Gabrielle Waclawik; Keely Browning; Aijan Urmat; Trevor L Schell; Ryan Smith; Antonio Huerta; Lauren Hipp; Sonya Dave; Neemit Shah; Kayla E Dillon; Katelyn Reiter-Schreurs; Rachel K Russ; Miguel A Mailig; Fauzia Osman; Francis A Farraye; Jennifer Weiss; Mary S Hayney; Freddy Caldera

doi:10.1093/crocol/otad078

Racial, Ethnic, and Geographic Disparities in Immunization Rates Among Patients With Inflammatory Bowel Disease

Crohns Colitis 360. 2023 Dec 14;5(4):otad078. doi: 10.1093/crocol/otad078. eCollection 2023 Oct.

Authors

Poonam Beniwal-Patel¹, Gabrielle Waclawik², Keely Browning¹, Aijan Urmat³, Trevor L Schell², Ryan Smith⁴, Antonio Huerta⁵, Lauren Hipp⁶, Sonya Dave⁶, Neemit Shah⁷, Kayla E Dillon³, Katelyn Reiter-Schreurs³, Rachel K Russ³, Miguel A Mailig³, Fauzia Osman², Francis A Farraye⁸, Jennifer Weiss⁴, Mary S Hayney³, Freddy Caldera⁴

Affiliations

¹ Medical College of Wisconsin, Division of Gastroenterology and Hepatology, Milwaukee, WI, USA.
² Department of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA.
³ School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA.
⁴ Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA.
⁵ University of Wisconsin School of Medicine & Public Health, Madison, WI, USA.
⁶ Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
⁷ Depatrment of Medicine, Medical College of Wisconsin School of Medicine, Milwaukee, WI, USA.
⁸ Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.

Abstract

Background and aims: Racial and ethnic disparities exist in the treatment of IBD. These disparities exist in adult vaccine uptake among the general population and may extend to patients with IBD. The primary aim of this study was to determine whether racial, ethnic, or geographic disparities existed in influenza vaccine uptake among patients with IBD.

Methods: We performed a multicenter, retrospective cohort study evaluating adult vaccine uptake among patients with IBD seen at two tertiary referral centers between September 2019 and February 2020. The primary outcome was to determine if racial/ethnic and geographic disparities existed in influenza vaccine uptake for the two prior seasons. Our secondary outcomes were to determine if disparities existed for pneumococcal, zoster, or hepatitis B vaccines.

Results: Among the 2453 patients who met the inclusion criteria, most identified as non-Hispanic White (89.9%), were on immunosuppressive therapy (74.5%), and received the influenza vaccine in both seasons (56.0%). Older age (prevalence ratio (PR) 0.98; 95% confidence interval (95%CI) 0.98-0.99; P < .001) and non-Hispanic White patients (PR 0.76, 95%CI 0.59-0.98, P < 0.03) were significantly more likely to be immunized. Black patients (PR 1.37; 95%CI 1.18-1.59; P < .001) and those living in underserved geographic areas (PR 1.35; 95%CI 1.17-1.56; P < 0.001) were less likely to be immunized. Racial/ethnic and geographic disparities were identified for pneumococcal, zoster, and hepatitis B vaccine uptake.

Conclusions: Racial and ethnic vaccination uptake disparities exist among patients with IBD; patients from medically underserved areas are also vulnerable to these disparities Studies identifying patient, provider, and system-level opportunities to address these disparities are needed.

Keywords: inflammatory bowel diseases; influenza vaccine; pneumococcal vaccines; recombinant zoster vaccine.