Do inflammatory bowel disease patient preferences from treatment outcomes differ by ethnicity and gender? A cross-sectional observational study

Timna Naftali; Vered Richter; Amir Mari; Tawfik Khoury; Haim Shirin; Efrat Broide

doi:10.12998/wjcc.v10.i35.12899

Do inflammatory bowel disease patient preferences from treatment outcomes differ by ethnicity and gender? A cross-sectional observational study

World J Clin Cases. 2022 Dec 16;10(35):12899-12908. doi: 10.12998/wjcc.v10.i35.12899.

Authors

Timna Naftali¹, Vered Richter², Amir Mari³, Tawfik Khoury³, Haim Shirin⁴, Efrat Broide⁵

Affiliations

¹ Institute of Gastroenterology, Meir Medical Center, Kfar-saba 4428164, Israel.
² Department of Gastroenterology, Shamir Medical Center, Zerifin 70300, Israel. veredr@shamir.gov.il.
³ Department of Gastroenterology, Nazareth Hospital, Nazareth 16100, Israel.
⁴ Shamir (Assaf Harofeh) Medical Center, Affiliated to Sackler School of Medicine, The Gonczarowski Family Institute of Gastroenterology and Liver Diseases, Tel Aviv University, Zerifin 70300, Israel.
⁵ Pediatric Gastroenterology Unit, Asaf Harofeh Medical Center, Zrifin 70300, Israel.

Abstract

Background: Inflammatory bowel disease (IBD) patients' expectations of treatment outcomes may differ by ethnicity.

Aim: To investigate treatment preferences of Jewish and Arabs patients.

Methods: This prospective survey ranked outcomes treatment preferences among Arab IBD patients, based on the 10 IBD-disk items compared to historical data of Jews. An anonymous questionnaire in either Arabic or Hebrew was distributed among IBD patients. Patients were required to rank 10 statements describing different aspects of IBD according to their importance to the patients as treatment goals. Answers were compared to the answers of a historical group of Jewish patients.

Results: IBD-disk items of 121 Arabs were compared to 240 Jewish patients. The Jewish patients included more females, [151 (62.9%) vs 52 (43.3%); P < 0.001], higher education level (P = 0.02), more urban residence [188 (78.3%) vs 54 (45.4%); P < 0.001], less unemployment [52 (21.7%) vs 41 (33.9%); P = 0.012], higher income level (P < 0.001), and more in a partnership [162 (67.8%) vs 55 (45.4%); P < 0.001]. Expectations regarding disease symptoms: abdominal pain, energy, and regular defecation ranked highest for both groups. Arabs gave significantly lower rankings (range 4.29-6.69) than Jewish patients (range 6.25-9.03) regarding all items, except for body image. Compared to Arab women, Jewish women attached higher priority to abdominal pain, energy, education/work, sleep, and joint pain. Multivariable regression analysis revealed that higher patient preferences were associated with Jewish ethnicity (OR 4.77; 95%CI 2.36-9.61, P < 0.001) and disease activity. The more active the disease, the greater the odds ratio for higher ranking of the questionnaire items (1-2 attacks per year: OR 2.13; 95%CI 1.02-4.45, P = 0.043; and primarily active disease: OR 5.29; 95%CI 2.30-12.18, P < 0.001). Factors inversely associated with higher patient preference were male gender (OR 0.5; 95%CI 0.271-0.935, P = 0.030), UC (OR 0.444; 95%CI 0.241-0.819, P = 0.009), and above average income level (OR 0.267; 95%CI: 0.124-0.577, P = 0.001).

Conclusion: The highest priority for treatment outcomes was symptom relief., Patients preferences were impacted by ethnicity, gender, and socio-economic disparity. Understanding patients' priorities may improve communication and enable a personalized approach.

Keywords: Crohn’s disease; Ethnicity; IBD-disk; Inflammatory bowel disease; Patients reported outcomes; Patients’ preferences; Ulcerative colitis.