title: Biological and Immunomodulator Use in Crohn's Disease in a Medicaid Population.
abstract: BACKGROUND
  Immunomodulator and biological use in African Americans (AA) with Crohn's disease (CD) has been reported to be lower than in whites (W); less data exist for Hispanics (H).
  
  
  METHODS
  Medicaid databases from 3 states were examined for patients with CD from August 1998 to July 2009. CD-related treatments, comorbidities, location, surgery, and health care utilization were assessed from diagnosis until the first biological claim or end of claims. A Cox proportional hazard regression model was used to assess the effect of race on biological initiation.
  
  
  RESULTS
  A total of 5575 patients with CD (3590 W; 924 AA; 494 H; and 567 "other") were analyzed; 18%, 17%, and 17% of W, AA, and H patients, respectively, started immunomodulators (P = not significant); and 7%, 9%, and 5% of W, AA, and H, respectively, initiated biologics after CD diagnosis (P = not significant). After adjusting for demographics and CD-related medications and comorbidities in Cox models, no association was found between AA and W for biological use (hazard ratio 1.19; 95% confidence interval [CI], 0.91-1.54) or H and W (hazard ratio 0.68, 95% CI, 0.45-1.02). Analyzing patients hospitalized after CD diagnosis (n = 3428) to adjust for disease severity demonstrated that H were significantly less likely to use biologics than W (hazard ratio 0.40, 95% CI, 0.22-0.74). No differences between W and AA were found.
  
  
  CONCLUSIONS
  Our findings suggest that differences between AA and W in exposure to immunomodulators or biologics may not exist, although they may be present in H with more severe disease. Further research is needed to confirm these findings.
authors.affiliation: *Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland; †AbbVie Inc., North Chicago, Illinois; and ‡Analysis Group Inc., Boston, Massachusetts.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Flasar
authors.forename: Jingdong
authors.initials: J
authors.lastname: Chao
authors.forename: A Burak
authors.initials: AB
authors.lastname: Ozbay
authors.forename: Martha
authors.initials: M
authors.lastname: Skup
authors.forename: Mei
authors.initials: M
authors.lastname: Lu
authors.forename: Raymond
authors.initials: R
authors.lastname: Cross
mesh_terms: D000328:Adult; D001741:Black or African American; D001685:Biological Factors / Q000627:therapeutic use*; D015897:Comorbidity; D003424:Crohn Disease / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D008484:Medicaid; D011379:Prognosis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D044465:White People
chemical_list: D001685:Biological Factors; D007155:Immunologic Factors