Emergency Department Utilization and Outpatient Care Continuity Among White and Hispanic Patients With Inflammatory Bowel Disease at a County Health System

TL;DR

Hispanic patients with inflammatory bowel disease had more emergency department visits than White patients, but both groups had similar outpatient care patterns.

Contribution

The study reveals racial disparities in emergency department use for IBD within a county health system.

Findings

Hispanic patients had significantly more IBD-related ED visits than White patients.

Rates of missed GI appointments and post-ED follow-up were similar between Hispanic and White patients.

Abstract

Introduction

Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, is associated with emergency department (ED) utilization and variable engagement with outpatient gastroenterology (GI) care. We examined ED utilization and outpatient GI care engagement among White and Hispanic patients with IBD within a county health system.

Methods

We conducted a retrospective cohort study of adult patients (≥18 years) with IBD receiving care within a single county health system between January 1, 2016, and December 31, 2024. Patients self-identifying as non-Hispanic White or Hispanic were included. Primary outcomes included the unadjusted count of IBD-related ED visits per patient during observed follow-up. Secondary outcomes included the presence of any ED visit, missed outpatient GI appointments, and GI follow-up within 90 days after an index ED visit among patients with at least one IBD-related ED visit and sufficient follow-up time. Comparisons were performed using chi-square testing for categorical variables and the Wilcoxon rank-sum test for continuous variables.

Results

Among 138 included patients, Hispanic patients experienced a significantly higher median number of IBD-related ED visits compared with White patients (P = 0.008), while the proportion of patients with at least one ED visit did not differ by race/ethnicity. Rates of missed GI appointments and outpatient GI follow-up within 90 days after ED encounters were similar between groups.

Conclusions

Within this county health system, Hispanic patients with IBD experienced more frequent ED utilization than White patients, without differences in outpatient GI follow-up following ED encounters.