Racial Disparities in the Diagnosis and Management Between Secondary Care Ethnic Minority and White British Patients With Irritable Bowel Syndrome

TL;DR

The study finds ethnic minority patients with IBS in the UK face longer diagnostic processes and less access to recommended treatments compared to white British patients.

Contribution

The study identifies racial disparities in IBS diagnosis and treatment adherence to guidelines in UK secondary care for the first time.

Findings

Ethnic minority patients required more clinicians and appointments for IBS diagnosis compared to white British patients.

Ethnic minority patients were less likely to receive second-line pharmacological and behavioral therapies.

Adherence to national IBS guidelines was poor across both ethnic groups.

Abstract

Irritable bowel syndrome (IBS) is a highly prevalent disorder of gut‐brain interaction best understood within a biopsychosocial framework. Recent studies in other healthcare systems have suggested racial disparities in the management of IBS.

We aimed to investigate racial disparities in the diagnosis and management of IBS including adherence to national guidelines between White British and Ethnic minority patients with IBS in a UK secondary care setting.

Consecutive Ethnic minority patients (N = 68) with a coded secondary care diagnosis of IBS at a gastroenterology department in a large UK teaching hospital were identified from electronic health records. Data on diagnostic pathways and access to treatments and adherence to national guidelines were compared statistically with an equal number of age and gender matched white British controls (N = 68).

Compared to age and gender matched White British controls, Ethnic Minority patients saw more clinicians (p = 0.012) and required more outpatient appointments to make an IBS diagnosis (p = 0.007). There were disparities identified in the approach to treatment, with ethnic minority patients less likely to be recommended second‐line pharmacological treatment (p = 0.004) and Brain‐Gut Behavioral Therapies (p = 0.005) compared to their White British counterparts. Across both groups, adherence to national guidelines in the diagnostic approach and treatment for IBS was low, with most patients not being recommended second‐line medical, dietary, or behavioral treatment for their IBS.

These data suggest that the management of IBS in secondary care in the UK has not kept pace with advances in evidence‐based treatments and updated guidelines. Moreover, racial disparities, whether influenced by clinicians or patients, were seen between the two ethnic groups regarding the diagnosis and management of IBS. Further studies are necessary to determine the barriers contributing to these disparities, to influence future interventions and clinical training to address them.

Compared to age and gender matched White British controls, ethnic minority patients with IBS in secondary care see on average more clinicians and require more clinic appointments to receive an IBS diagnosis.Ethnic minority patients are also less likely to be recommended second‐line pharmacological and brain‐gut behavioural therapies than White British patients with IBS in secondary care.Overall, regardless of ethnic group, adherence to IBS diagnosis and management guidelines in secondary care appears to be poor.

Compared to age and gender matched White British controls, ethnic minority patients with IBS in secondary care see on average more clinicians and require more clinic appointments to receive an IBS diagnosis.

Ethnic minority patients are also less likely to be recommended second‐line pharmacological and brain‐gut behavioural therapies than White British patients with IBS in secondary care.

Overall, regardless of ethnic group, adherence to IBS diagnosis and management guidelines in secondary care appears to be poor.

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