title: Racial and ethnic differences in health care utilization and outcomes among ulcerative colitis patients in an integrated health-care organization.
abstract: BACKGROUND
  Current knowledge of racial disparities in healthcare utilization and disease outcomes for ulcerative colitis (UC) is limited. We sought to investigate these differences among Caucasian, African American, Asian, and Hispanic patients with ulcerative colitis in Kaiser Permanente, a large integrated health-care system in Northern California.
  
  
  METHODS
  This retrospective cohort study used computerized clinical data from 5,196 Caucasians, 387 African-Americans, 550 Asians, and 801 Hispanics with prevalent UC identified between 1996 and 2007. Healthcare utilization and outcomes were compared at one and five-year follow-up by use of multivariate logistic regression analysis.
  
  
  RESULTS
  Compared with whites, the male-to-female ratio differed for African-Americans (0.68 vs. 0.91, p < 0.01) and Asians (1.3 vs. 0.91, p < 0.01). Asians had fewer co-morbid conditions (p < 0.01) than whites, whereas more African-Americans had hypertension and asthma (p < 0.01). Use of immunomodulators did not differ significantly among race and/or ethnic groups. Among Asians, 5-ASA use was highest (p < 0.05) and the incidence of surgery was lowest (p < 0.01). Prolonged steroid exposure was more common among Hispanics (p < 0.05 at 1-year) who also had more UC-related surgery (p < 0.01 at 5-year) and hospitalization (<0.05 at 5-year), although these differences were not significant in multivariate analysis.
  
  
  CONCLUSIONS
  In this population of UC patients with good access to care, overall health-care utilization patterns and clinical outcomes were similar across races and ethnicity. Asians may have milder disease than other races whereas Hispanics had a trend toward more aggressive disease, although the differences we observed were modest. These differences may be related to biological factors or different treatment preferences.
authors.affiliation: Department of Gastroenterology, Kaiser Permanente Northern California, Santa Clara, CA, USA, Dan.X.Li@kp.org.
authors.forename: Dan
authors.initials: D
authors.lastname: Li
authors.forename: Bernadette
authors.initials: B
authors.lastname: Collins
authors.forename: Fernando S
authors.initials: FS
authors.lastname: Velayos
authors.forename: Liyan
authors.initials: L
authors.lastname: Liu
authors.forename: James D
authors.initials: JD
authors.lastname: Lewis
authors.forename: James E
authors.initials: JE
authors.lastname: Allison
authors.forename: Nicole T
authors.initials: NT
authors.lastname: Flowers
authors.forename: Susan
authors.initials: S
authors.lastname: Hutfless
authors.forename: Oren
authors.initials: O
authors.lastname: Abramson
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Herrinton
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D001213:Asian / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data* / Q000639:trends; D006295:Health Resources / Q000706:statistics & numerical data* / Q000639:trends; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult