Crohn's disease: Does race matter?

OBJECTIVE: The severity of Crohn's disease (CD) has been reported to be gre ater in blacks than in whites. This possible disparity may be due, in part, to differences between these groups in health care utilization and accessi bility. To explore these issues, we conducted a multicenter survey of patie nts with CD. METHODS: One-hundred and forty-five blacks with CD, recruited from four tea ching hospitals and five private practices, and identified by medical recor d review or ICD-9 code, were enrolled and matched to 407 whites with CD (by age, gender, and practice type [teaching vs private practice setting]). Pa rticipants were interviewed regarding medical history, health status, perso nal health care practices during the preceding 5 yr, and beliefs regarding health care in the general population. RESULTS: Blacks and whites were similar with respect to age of CD onset, la g in time to diagnosis, and number of gastrointestinal (GI)-related hospita lizations and surgeries. Medication usage patterns were also similar in the two groups. Quality of life, measured by SF-36, was lower in all categorie s for blacks, compared with whites. Blacks were more likely to have had to stop work (p < 0.01) and have lost more work days (p < 0.01) than were whit es. Whites were mon likely to have health insurance and be able to identify a regular provider than were blacks. Blacks were more likely to report the following: receiving Medicaid; difficulty affording health care; delaying appointments due to financial concerns; difficulty traveling to their provi der's office; and experiencing unreasonable delays at their provider's offi ce. After adjusting for potential confounding variables, we found no differ ences between the groups, except for the number of days of work lost becaus e of CD. CONCLUSIONS: These data suggest that black and white patients have similar reported disease presentations and course, and contrast with prior reports suggesting a more severe disease course among black patients. Although the disease itself appears similar, there were numerous reported differences be tween the races in health care utilization practices and in disease impact upon daily activities. We suggest that apparent disparities in CD according to race are actually due to social and economic factors, and not to the di sease itself. (C) 2000 by Am. Cell. of Gastroenterology.