The Impact and Interactions of Race and Gender on Healthcare Use and Spending Irritable Bowel Syndrome

Abstract

Background & aims: Studies examining the effects of social determinants of health on healthcare use in irritable bowel syndrome (IBS) are scarce. We aimed to assess healthcare spending among different racial/ethnic groups and genders in adults with IBS. Methods: We performed a retrospective cohort analysis of adults diagnosed with IBS between 2016 and 2021 using Optum's de-identified Clinformatics Data Mart database. We analyzed total annual and IBS-specific costs, utilization and costs of individual services, and prescriptions. We compared outcomes across racial/ethnic groups and by gender after adjusting for covariates and examined race-gender interactions. Results: Among 95,319 adults with IBS, healthcare spending varied significantly by race and gender. Total all-cause and IBS-specific costs were lower in men than in women and in Asian and Hispanic patients than in White patients. Compared with White patients, Black patients had higher total IBS-specific costs, all-cause prescription costs, IBS-related radiology and laboratory costs, and emergency department (ED) care, while Asian and Hispanic patients incurred lower costs for ED care, hospitalizations, and all-cause prescriptions. Endoscopy costs were lower in racial minority groups. Women had higher spending for most services compared with men, but gender differences in most IBS-related services were small. All-cause hospitalization and endoscopy costs were higher in men, but IBS-specific hospitalization and endoscopy costs were higher in women. Gender disparities in all-cause individual services also varied by race. Conclusions: Overall and IBS-related spending is higher in women, but gender differences in IBS-related care are small. Racial/ethnic comparisons show reduced spending in Asian and Hispanic patients, increased ED care in Black patients, and variations in spending patterns. Gender disparities differ by race.