Are There Racial Disparities in Ulcerative Colitis?

When doctors miss symptoms of UC in people of color, it leads to delays in diagnosis and treatment. That may be one reason statistics show Black people get diagnosed at an older age than people of other races.

When UC isn't diagnosed early, it can progress and lead to complications such as:

• Strictures, areas of narrowing and scarring in the intestines
• Fistulas, abnormal tunnels that form between the intestines and other organs
• Abscesses, areas of infection
• Colorectal cancer

UC Medicine and Race

Treatment for UC usually involves medication, surgery, or a combination of both. Medicines called immunomodulators and biologics work on the immune system to slow the disease and sometimes put it into remission. Corticosteroids stop flares by dialing down the immune system. 

People of different races may not get the same medicines for UC. In some studies, doctors were less likely to prescribe immunomodulators and biologics for Black, Hispanic, and Asian people. Doctors also prescribed steroids less often for Black people than they did for White people. Other studies didn't show any differences in medicine prescribing.

Hospital Stays

Up to 25% of people with UC need treatment in a hospital at some point. Typically this is because they have a severe flare that their medication isn’t able to control. 

More than twice as many Black people have to go to the hospital because of IBD than White or Hispanic people. Hospital stays are also rising among Asian people.

Differences in Surgery Outcomes

Most people can manage UC symptoms with medication and diet. But those with more severe symptoms may need surgery to remove their colon (colectomy) or their colon and rectum (proctocolectomy). 

Black and Hispanic people with IBD seem to have worse outcomes after surgery than White people do. They need to stay in the hospital longer after surgery, have more complications, and are more likely to return to the hospital later because of post-surgery problems.

A program called Enhanced Recovery After Surgery (ERAS) is helping to improve surgery outcomes for people of all races. ERAS streamlines the process before, during, and after surgery to reduce complications. Research shows that this program equalizes surgical outcomes for people of all races.

What Causes Racial Disparities in UC?

There are a few possible reasons for the disparities in UC outcomes between White people and people of color.

Lack of access to care. UC is a chronic disease that requires long-term treatment to manage symptoms and prevent complications. Having access to a gastroenterologist — a specialist who treats UC — and going for regular follow-up visits is key to having a good outcome. 

Studies show Black people are much less likely to see a gastroenterologist or other IBD specialist than White people. Instead, they often get treated in the emergency room after they've already developed complications. 

Delayed diagnosis. A lack of access to specialists and assumptions in the medical community that UC is a White person's disease could slow the process of getting a diagnosis for people of color. That may be why they often have disease that’s progressed or have already developed complications by the time they see a doctor.

No insurance coverage. IBD treatments are effective but expensive. Managing UC can cost around $23,000 a year. Insurance coverage can make the difference between affording treatment and going without. That's especially true for people of low income, and Black Americans with IBD typically earn less money than the national average. 

The type of insurance you have could also affect your likelihood of having an IBD surgery you need. White and Asian people with IBD are more likely to have private health insurance, while Blacks and Hispanics more often have Medicaid or no health insurance. Research shows that people who have Medicaid or Medicare are less likely to have surgery than those with private insurance. 

Outcomes also differ by type of insurance. People with Medicaid are three times more likely to die after UC surgery than those with private insurance. This may be because of longer wait times for surgery. 

Problems sticking to an IBD diet. Watching what you eat is an important part of managing UC. Certain foods like raw vegetables, fruits with skin, dairy, and sugar can make flares worse. Eating meals together as a family is a big part of certain cultures. Feeling pressured to eat the same way as the rest of your family could be a barrier to following the recommended IBD diet. 

Stopping treatment. Medication is important to managing IBD. Going off IBD medication could lead to worse symptoms and complications. Some studies have shown that Black people cut their treatment short more often than White people do. Other studies found that people of all races were equally good about taking their medication.