S1513 Disparities in Ulcerative Colitis Complications by Race and Gender: A Multicenter Propensity-Matched Cohort Study

Introduction: Racial and gender disparities in ulcerative colitis (UC) outcomes persist despite therapeutic advances. We evaluated differences in UC complications and interventions across racial and gender groups using a large, real-world electronic health record database. Methods: We conducted a retrospective cohort study using the TriNetX database, analyzing adult patients (≥18 years) with a diagnosis of UC from 2010 to 2025. Propensity score matching was performed to compare cohorts of (1) Black vs White (N = 32,121 each), (2) Hispanic vs White (N = 19,928 each), and (3) men vs women (N = 153,065 each). Primary outcomes included mortality, and UC-related complications such as development of colorectal cancer, rectal bleeding, intestinal obstruction, bowel perforation, and fistula formation. Risk ratios, odds ratios, and Kaplan-Meier survival analyses were employed. Results: In the Black vs White cohort, Black patients had significantly higher all-cause mortality (6.0% vs 5.6%, OR 1.08, P = 0.017) despite lower rates of colectomy (1.9% vs 2.5%, OR 0.75, P < 0.001). Rates of colon cancer and all other complications were similar between the 2 groups. In the Hispanic vs White cohort, Hispanic patients exhibited significantly higher rates of rectal bleeding (11.8% vs 9.8%, OR 1.23, P < 0.001), while all other complications did not reach statistical significance. Mortality and colectomy rates were not significantly different. Among men vs women patients, men had significantly higher mortality (5.6% vs 4.8%, OR 1.18, P < 0.001), colorectal cancer (2.3% vs 1.6%, OR 1.44, P < 0.001), and colectomy rates (2.5% vs 2.0%, OR 1.28, P < 0.001), along with increased risks of abscess, perforation, and rectal bleeding. Conclusion: Despite similar UC complication rates and matched demographics, Black patients had significantly higher all-cause mortality and lower colectomy rates compared to White patients, suggesting systemic disparities and barriers to timely surgical and specialty care. Men had higher risks of UC complications including colorectal cancer, perforation, surgery, and mortality, consistent with findings from prior studies. These findings highlight the need for equity-focused strategies that address both clinical management and the broader social factors influencing UC outcomes.