title: Systematic review: The role of race and socioeconomic factors on IBD healthcare delivery and effectiveness.
abstract: BACKGROUND
  Race and socioeconomic status (SES) significantly affect the content and delivery of healthcare for multiple chronic disease states. Inflammatory bowel disease (IBD) is a set of complex, chronic diseases with the potential for significant morbidity if the content or delivery of healthcare is suboptimal. However, the literature related to race, SES, and IBD remains fragmented.
  
  
  METHODS
  Using guidelines published by the Centre for Reviews and Dissemination, we performed a systematic review of the world's literature to identify studies related to: 1) IBD, 2) race/ethnicity, 3) SES, 4) healthcare delivery, and 5) healthcare effectiveness.
  
  
  RESULTS
  We identified 40 studies that met inclusion criteria. Twenty-four studies (60%) assessed the role of SES and 21 (53%) evaluated race. Topics addressed by these studies included: 1) Utilization of Medical and Surgical Therapy; 2) Adherence to Medical Therapy; 3) Clinical Outcomes; 4) Healthcare Access and Utilization; 5) Disease Perception and Knowledge; and 6) Employment/Insurance. We identified race- and SES-based disparities in the content of medical and surgical healthcare, utilization of inpatient and ambulatory medical care, adherence to medical therapy, and disease perceptions and knowledge. Several studies also identified race- and SES-based disparities in outcomes for IBD, including in-hospital mortality rates and health-related quality of life.
  
  
  CONCLUSIONS
  Race- and SES-based disparities in the delivery and effectiveness of healthcare for patients with IBD exist in numerous domains, yet studies remain limited in their scope and breadth. Concerted, prospective, multicenter efforts are needed to address underlying causes for disparities and to identify methods of reducing and eliminating disparities.
authors.affiliation: Center for Innovation in Access and Quality, Division of Gastroenterology and Hepatology, San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, California 94143, USA.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Sewell
authors.forename: Fernando S
authors.initials: FS
authors.lastname: Velayos
mesh_terms: D014943:Global Health; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000191:economics / Q000208:ethnology / Q000628:therapy*; D055118:Medication Adherence / Q000208:ethnology; D008913:Minority Groups; D011788:Quality of Life; D044469:Racial Groups; D012923:Social Class; D012959:Socioeconomic Factors