S1661 Racial Disparities in Biologic Therapy Initiation for Inflammatory Bowel Disease: A Real-World Multicenter Cohort Study

Introduction: Biologic agents have revolutionized inflammatory bowel disease (IBD) management with improved mucosal healing and decreased steroid dependence. Racial disparities limit access to newer medications. Identifying racial disparities in biologic initiation is essential to inform equitable care strategies and improve outcomes. Methods: This is a retrospective cohort study that included Adults (≥18 years) with a diagnosis of Crohn’s disease or Ulcerative colitis. Stratified into 2 groups of White and black patients. Outcomes include time to biologic initiation of 7 agents. Time to steroid use. Risk of ER visits and surgery (colectomy, bowel resection). Propensity score matching (PSM) was performed for demographics, prior medication use, and confounding comorbidities. Results expressed in the form of risk difference (RD). Time to event endpoints using Kaplan-Meier curves and Cox proportional hazards models reported as hazard ratio (HR) and log-rank P values. Results: 52744 IBD patients were identified in each group: White and black. Time-to-event analysis, White patients were 17% more likely to initiate a biologic (HR 1.17, 95% CI 1.13–1.22; P < 0.0001). Glucocorticoid dependence was similar (47.2% vs 47.6%; risk difference –0.37%, P = 0.35), yet African Americans reached steroid use sooner (HR 0.90, 95% CI 0.88–0.92). Black patients experienced a higher colectomy risk (1.80% vs 1.61%; risk ratio 1.12, P = 0.018) and were more likely to utilize the emergency department (23.8% vs 20.7%; risk ratio 1.15, risk difference 3.0%, P < 0.0001), averaging more visits when they did present (P < 0.0001). Conclusion: In summary, these findings demonstrate delayed biologic initiation and greater acute-care utilization among black IBD patients, showing disparities for biologic access in black patients diagnosed with IBD.