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Racial and Geographic Disparities in the Use of Parenteral Nutrition Among Inflammatory Bowel Disease Inpatients Diagnosed With Malnutrition in the United States

From ¹ Mount Sinai Hospital IBD Centre, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada;² Harvey M. and Lyn P. Meyerhoff IBD Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and ³ Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Address correspondence to: Geoffrey C. Nguyen, MD, PhD, FRCPC, 600 University Ave, Ste 437, Toronto, Ontario M5G 1X5; e-mail: gnguyen{at}mtsinai.on.ca.

Background: Racial disparities have been described in the use of a diverse spectrum of surgical procedures. The objectives of this study are to determine whether disparities also exist for the use of parenteral nutrition (PN) in inflammatory bowel disease (IBD). Methods: The U.S. Nationwide Inpatient Sample between 1998 and 2003 is analyzed to determine PN use among IBD inpatients diagnosed with protein-calorie malnutrition and assess whether use patterns differ by race and geographical region. Results: The proportion of African American IBD admissions with protein-calorie malnutrition who receive PN is significantly lower than that in whites (19.9% vs 28.1%, P = .001), whereas there is no difference between Hispanics and non-Hispanic whites. After adjustment for gender, comorbidity, health insurance status, geographic region, and median neighborhood income, African Americans remain less likely than whites to receive PN (odds ratio [OR] 0.67; 95% confidence interval [CI], 0.50–0.89), whereas the difference between Hispanics and non-Hispanic whites is marginally significant (OR 0.65; 95% CI, 0.41–1.04). PN use varies geographically, with highest rates in the Northeast (44.3%) and lowest in the Midwest (17.3%). Uninsured patients are less than half as likely to receive PN as those with insurance (OR 0.46; 95% CI, 0.31–0.69). Compared with whites, Hispanics experience a longer time interval between admission and initiation of PN (3.5 vs 4.8 days, P = .02) and have higher rates of catheter-related complications (5.1% vs 12.2%, P = .04). Conclusions: Among IBD inpatients with clinically diagnosable malnutrition, PN use is lower among African Americans compared with whites. The underlying mechanisms of these racial variations merit further investigation.

Key Words: African American • Crohn's disease • Hispanic • inflammatory bowel disease • malnutrition • parenteral nutrition • racial disparity • ulcerative colitis

This version was published on September 1, 2009

Journal of Parenteral and Enteral Nutrition, Vol. 33, No. 5, 563-568 (2009)
DOI: 10.1177/0148607109332907


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