B0396 - Racial and Ethnic Disparities in Health-Related Quality of Life in Patients With Inflammatory Bowel Disease: Results From the National Health and Wellness Survey

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

AP

Aarti A. Patel, PharmD, MBA

Janssen Scientific Affairs, LLC
Titusville, NJ

Sabree Burbage, PharmD, MPH¹, Kathryn Krupsky, PhD², M. Janelle Cambron-Mellott, PhD³, Nate Way, PhD³, Aarti A. Patel, PharmD, MBA⁴, Julia Liu, MD, MS⁵
¹Janssen Scientific Affairs, LLC, Horsham, PA; ²Cerner Enviza, North Kansas City, MO; ³Cerner Enviza, Malvern, PA; ⁴Janssen Scientific Affairs, LLC, Titusville, NJ; ⁵Morehouse School of Medicine, Decatur, GA

Introduction: Racial and ethnic disparities in health-related quality of life (HRQoL) have been observed in several conditions, with Black, Indigenous, and People of Color (BIPOC) reporting worse outcomes than White individuals. Here, sociodemographics and patient-reported outcomes (PROs) were compared in White, Black, and Hispanic individuals with inflammatory bowel disease (IBD).

Methods: Data were obtained from the National Health and Wellness Survey (NHWS; 2018-2020). Adults with a self-reported physician diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC) were included. Bivariate (interim) analyses were conducted to compare sociodemographics and PROs across racial/ethnic groups.

Results: Analyses included 1,077 participants with CD (818 White, 109 Black, and 150 Hispanic) and 1,500 with UC (1,150 White, 99 Black, and 251 Hispanic). Black and Hispanic participants were younger than White participants with CD or UC (P< 0.001). A higher proportion of Black participants with CD had not completed a college program than White participants, and a higher proportion of Hispanic participants with CD and UC were employed full time than White participants (P< 0.05). Hispanic participants had significantly worse HRQoL across several PROs (including PHQ-9, GAD-7, MCS, SF-6D index, and EQ-5D index; see table) than White or Black participants with CD or UC (P< 0.001 for all Hispanic vs. White comparisons for above-listed PROs; P≤0.038 for PHQ-9, GAD-7, and EQ-5D index only for Hispanic vs. Black). Hispanic participants with CD also had greater mean percent work impairment assessed using the Work Productivity and Activity Impairment (WPAI) questionnaire than White (P< 0.001) or Black (P≤0.038 for all components except absenteeism) participants. Hispanic and Black participants with UC had worse WPAI outcomes than White participants (all components P≤0.001 for Hispanic vs. White; P≤0.049 for absenteeism and overall work productivity impairment only for Black vs. White).

Discussion: Results indicated that Hispanic participants with IBD had worse HRQoL and WPAI outcomes than White or Black participants, supporting important distinctions between racial and ethnic groups. Differences in sociodemographics were also observed between groups. Notably, sociodemographics for NHWS participants, including Hispanics, differ from national estimates. Further research is needed to better understand the factors impacting HRQoL in different racial and ethnic groups with IBD.

	CD (N = 1,077)			UC (N = 1,500)
	White (n = 818)	Black (n = 109)	Hispanic (n = 150)	White (n = 1,150)	Black (n = 99)	Hispanic (n = 251)
Female, n (%)	421 (51.5%)	55 (50.5%)	55 (36.7%)^†	696 (60.5%)	47 (47.5%)*	138 (55.0%)
Age in years, mean (SD)	48.34 (16.48)	36.84 (14.39)*	34.05 (11.05)^†	52.48 (16.28)	38.48 (16.08)*	38.45 (14.27)^†
Marital status, n (%) Married/living with a partner Single, not married/divorced/ separated/widowed Decline to answer	518 (63.3%) 299 (36.6%) 1 (0.1%)	37 (33.9%)* 71 (65.1%)* 1 (0.9%)	94 (62.7%)^‡ 56 (37.3%)^‡ 0 (0.0%)	718 (62.4%) 429 (37.3%) 3 (0.3%)	29 (29.3%)* 70 (70.7%)* 0 (0.0%)	125 (49.8%)^†,‡ 124 (49.4%)^†,‡ 2 (0.8%)
Education, n (%) Less than a college graduate College graduate or higher Decline to answer	383 (46.8%) 434 (53.1%) 1 (0.1%)	66 (60.6%)* 43 (39.4%)* 0 (0.0%)	81 (54.0%) 69 (46.0%) 0 (0.0%)	564 (49.0%) 582 (50.6%) 4 (0.3%)	59 (59.6%) 39 (39.4%) 1 (1.0%)	133 (53.0%) 118 (47.0%) 0 (0.0%)
Employment status, n (%) Employed full time Self-employed Employed part time Homemaker Retired Student Long-Term Disability Not employed (whether looking for work or not)	364 (44.5%) 54 (6.6%) 83 (10.1%) 39 (4.8%) 159 (19.4%) 21 (2.6%) 56 (6.8%) 42 (5.1%)	56 (51.4%) 9 (8.3%) 14 (12.8%) 7 (6.4%) 2 (1.8%)* 9 (8.3%)* 5 (4.6%) 7 (6.4%)	94 (62.7%)^† 13 (8.7%) 12 (8.0%) 3 (2.0%) 9 (6.0%)^† 7 (4.7%) 5 (3.3%) 7 (4.7%)	424 (36.9%) 78 (6.8%) 85 (7.4%) 73 (6.3%) 321 (27.9%) 16 (1.4%) 84 (7.3%) 69 (6.0%)	44 (44.4%) 9 (9.1%) 17 (17.2%)* 3 (3.0%) 9 (9.1%) 8 (8.1%) 2 (2.0%) 7 (7.1%)	132 (52.6%)^† 15 (6.0%) 30 (12.0%) 19 (7.6%) 29 (11.6%) 8 (3.2%) 12 (4.8%) 6 (2.4%)
Household income, n (%) < $25,000 $25,000 to < $50,000 $50,000 to < $100,000 $100,000+ Decline to answer	102 (12.5%) 163 (19.9%) 289 (35.3%) 246 (30.1%) 18 (2.2%)	32 (29.4%)* 20 (18.3%) 29 (26.6%) 27 (24.8%) 1 (0.9%)	16 (10.7%) 29 (19.3%) 47 (31.3%) 57 (38.0%) 1 (0.7%)	166 (14.4%) 235 (20.4%) 409 (35.6%) 299 (26.0%) 41 (3.6%)	22 (22.2%)* 25 (25.3%) 29 (29.3%) 23 (23.2%) 0 (0.0%)	39 (15.5%) 53 (21.1%) 74 (29.5%) 77 (30.7%) 8 (3.2%)
Health insurance, n (%) Not insured Commercially insured Medicaid Medicare Other type of insurance/unsure	58 (7.1%) 456 (55.7%) 81 (9.9%) 203 (24.8%) 20 (2.4%)	16 (14.7%)* 65 (59.6%) 10 (9.2%) 15 (13.8%)* 3 (2.8%)	21 (14.0%)^† 91 (60.7%) 11 (7.3%) 14 (9.3%)^† 13 (8.7%)^†	88 (7.7%) 583 (50.7%) 85 (7.4%) 362 (31.5%) 32 (2.8%)	11 (11.1%) 54 (54.5%) 13 (13.1%) 16 (16.2%)* 5 (5.1%)	37 (14.7%)^† 149 (59.4%)^† 21 (8.4%) 27 (10.8%)^† 17 (6.8%)^†
HRQoL, mean (SD) PHQ-9 score^a GAD-7 score^b MCS score^c PCS score^c SF-6D Index score^c EQ-5D Index score^d EQ VAS score	8.75 (7.40) 6.55 (6.16) 41.76 (11.94) 43.80 (10.29) 0.630 (0.14) 0.724 (0.21) 63.56 (24.95)	8.33 (5.71) 6.68 (4.99) 40.86 (10.79) 44.16 (9.47) 0.612 (0.13) 0.720 (0.17) 60.54 (29.98)	12.56 (7.23)^†,‡ 9.49 (5.83)^†,‡ 36.90 (9.90)^†,‡ 41.96 (8.16) 0.556 (0.12)^†,‡ 0.628 (0.23)^†,‡ 61.38 (28.27)	7.51 (7.02) 5.57 (5.59) 43.67 (12.24) 44.46 (10.33) 0.647 (0.14) 0.739 (0.19) 64.43 (25.91)	8.57 (6.70) 6.53 (5.21) 41.96 (11.02) 44.61 (8.48) 0.618 (0.16) 0.747 (0.16) 67.75 (28.53)	10.65 (7.28)^†,‡ 8.31 (5.47)^†,‡ 38.71 (9.93)^† 43.67 (8.91) 0.586 (0.13)^† 0.670 (0.21)^†,‡ 63.73 (27.16)
WPAI^e, mean % (SD) Absenteeism Presenteeism Overall work productivity impairment Activity impairment	19.16 (26.28) 41.46 (34.06) 45.47 (36.72) 43.47 (31.59)	25.97 (27.50) 40.13 (31.43) 50.03 (35.17) 44.77 (28.98)	31.09 (28.64)^† 55.74 (30.00)^†,‡ 63.43 (32.09)^†,‡ 57.07 (29.66)^†,‡	16.26 (25.68) 35.46 (33.05) 39.23 (35.94) 40.28 (31.63)	24.43 (28.78)* 42.06 (34.01) 50.24 (38.80)* 45.45 (35.72)	29.51 (26.84)^† 51.30 (30.35)^† 60.28 (32.45)^† 48.45 (29.25)^†

Table: Sociodemographics and patient-reported outcomes in White, Black, and Hispanic participants with IBD.

a PHQ-9 includes nine items (range of 0 to 27) where higher scores indicate mores severe depression.
b GAD-7 includes seven items (range 0 to 21) and a higher score indicates more severe general anxiety disorder.
c Differences in 3 points on the norm-based component summary scores and 0.041 points on health utilities represent clinically meaningful differences.
d The minimally important difference for this measure is considered to be approximately 0.074 points.
e Absenteeism was not calculated for those who worked zero hours and missed zero hours in the last seven days and presenteeism was only asked among those who worked more than zero hours in the last seven days.
* P < 0.05 between Black/African American and White participants. † P < 0.05 between Hispanic and White participants. ‡ P < 0.05 between Hispanic and Black/African American participants.
Note: P values were calculated using Bonferroni-adjusted pairwise comparisons.
Abbreviations: CD = Crohn’s Disease; EQ = EuroQoL; GAD = general anxiety disorder; HRCU = healthcare resource utilization; HRQoL = health-related quality of life; IBD = inflammatory bowel disease; MCS = mental component summary; PAM = patient activation measure; PCS = physical component summary; PHQ = patient health questionnaire; SF = short form; UC = ulcerative colitis; VAS = visual analogue scale; WPAI = work productivity and activity impairment.

Disclosures:

Sabree Burbage: Janssen Scientific Affairs – Employee, Stock-privately held company.

Kathryn Krupsky: Janssen – Employee of Cerner Enviza, who received funding to conduct this study.

M. Janelle Cambron-Mellott: Janssen – Employee of Cerner Enviza, who received funding to conduct this study.

Nate Way: Janssen Scientific Affairs – mployee of Cerner Enviza, who received funding to conduct this study.

Aarti Patel: Janssen Scientific Affairs, LLC – Employee, Stock-publicly held company(excluding mutual/index funds).

Julia Liu indicated no relevant financial relationships.

Sabree Burbage, PharmD, MPH¹, Kathryn Krupsky, PhD², M. Janelle Cambron-Mellott, PhD³, Nate Way, PhD³, Aarti A. Patel, PharmD, MBA⁴, Julia Liu, MD, MS⁵. B0396 - Racial and Ethnic Disparities in Health-Related Quality of Life in Patients With Inflammatory Bowel Disease: Results From the National Health and Wellness Survey, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.