Disparities in child height at the time of inflammatory bowel disease diagnosis

OBJECTIVES: Growth delay is associated with severe disease at inflammatory bowel disease (IBD) diagnosis. Variation in height at diagnosis is unknown. We hypothesize that growth delay at diagnosis is more common among individuals of low socioeconomic status. METHODS: We retrospectively evaluated prospectively collected data from patients <18 year and enrolled in the ImproveCareNow (ICN) Network <90 days after IBD diagnosis. The primary outcome was growth delay at enrollment, defined as height Z-score <-1. Insurance was dichotomized as presence or absence of private insurance. RESULTS: Among 13,691 patients included, 6015 were female (44%), median age 13.6 year (interquartile range 11.0-15.8), 1583 (11.6%) Black, 9951 (72.7%) White, 935 (6.8%) other race, 723 (5.3%) Hispanic/Latino and 10,154 (74.2%) non-Hispanic/Latino ethnicity, and 9425 (68.8%) with, and 3011 (22.0%) without private insurance. Patients without private insurance were 20% more likely to have growth delay (N = 728, 24.2%) than those with private insurance (N = 1894, 20.1%; p < 0.001). Among Hispanic/Latino patients, 25.7% (N = 186) had growth delay, compared to 20.7% (N = 2,098) non-Hispanic/Latino (p = 0.001). Hispanic/Latino patients without private insurance had the greatest proportion with growth delay (N = 107, 28.6%) compared to all others (N = 2762, 20.7%; p < 0.001). CONCLUSIONS: Hispanic/Latino children and those without private insurance are more likely to have growth delay at IBD diagnosis. Diagnostic delay and food insecurity are likely contributors. Medical care should be equitable despite life circumstance. This study identifies opportunities to improve care by emphasizing the importance of timely diagnosis. Improving access is necessary at each phase of care to ensure equitable timely diagnosis for all patients.