In Patients With Inflammatory Bowel Disease, Racial Disparities Exist in Burden of Vaccine-preventable Disease Hospitalizations and Outcomes

Christian Karime; Miguel Salazar; Cecily N Black; Freddy Caldera; Philip N Okafor; Muhammad B Hammami; Jana G Hashash; Francis A Farraye

doi:10.1097/MCG.0000000000002005

In Patients With Inflammatory Bowel Disease, Racial Disparities Exist in Burden of Vaccine-preventable Disease Hospitalizations and Outcomes

J Clin Gastroenterol. 2024 Apr 16. doi: 10.1097/MCG.0000000000002005. Online ahead of print.

Authors

Christian Karime¹, Miguel Salazar², Cecily N Black¹, Freddy Caldera³, Philip N Okafor⁴, Muhammad B Hammami², Jana G Hashash⁵, Francis A Farraye⁵

Affiliations

¹ Department of Internal Medicine.
² Department of Gastroenterology and Hepatology, University of California, Riverside, CA.
³ Department of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
⁴ Department of Gastroenterology and Hepatology.
⁵ Department of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center, Mayo Clinic, Jacksonville, FL.

PMID: 38619208
DOI: 10.1097/MCG.0000000000002005

Abstract

Objective: Patients with inflammatory bowel disease (IBD) are at increased risk of vaccine-preventable diseases (VPDs). Despite the increasing prevalence of IBD in non-white populations, little is known regarding racial disparities in VPD burden.

Methods: Retrospectively analyzing the 2016 to 2020 National Inpatient Sample, we identified adults with IBD hospitalized for a principal diagnosis of VPD. The primary outcome investigated was hospitalization for VPD stratified by patient-reported race. Secondary outcomes were in-hospital morbidity, mortality, length of stay, and health care utilization. Multivariable regression analysis was performed to adjust for patient and hospital characteristics.

Results: The search identified 554,114 hospitalizations for VPD, including 4170 hospitalizations in patients with IBD. Patients with IBD had significantly greater odds of hospitalization from herpes zoster virus (adjusted odds ratio [aOR]: 1.73) and varicella zoster virus (aOR: 2.31). Comparing white and non-white patients with IBD, significant racial disparities were noted. Non-white patients were at greater odds of hospitalization from influenza (aOR: 1.74), herpes zoster virus (aOR: 1.77), and varicella zoster virus (aOR: 1.62). In-hospital morbidity was greater in non-white patients, including greater odds of requiring intensive care unit stay (aOR: 1.18). Morbidity was elevated in African Americans, with greater odds of acute kidney injury (aOR: 1.25), venous thromboembolism (aOR: 1.17), respiratory failure (aOR: 1.16), and intensive care unit stay (aOR: 1.18). No differences were found in mortality, length of stay, and health care utilization.

Conclusions: Significant racial disparities in VPD hospitalization and in-hospital morbidity were found among adults with IBD in the United States. With the increasing prevalence of IBD in non-white populations, targeted efforts are needed to improve health equity.