Erica Brenner, MD, and Manasi Agrawal, MD, on the Impact of COVID-19 Among Minority Patients With IBD

In this podcast, Erica Brenner, MD, and Manasi Agrawal, MD, discuss some highlights and important takeaways from their study, "COVID-19 Outcomes Among Racial and Ethnic Minority Individuals with Inflammatory Bowel Disease in the United States."

Erica Brenner, MD, completed a pediatric gastroenterology fellowship with University of North Carolina, and is beginning an inflammatory bowel disease-specific fellowship.

Manasi Agrawal, MD, is an assistant professor in medicine in the Division of Gastroenterology at the Icahn School of Medicine at Mount Sinai in New York.

TRANSCRIPT:

Angelique Platas:  Welcome to another podcast from the Gastroenterology Learning Network. I'm your host, Angelique Platas. Today, I'll be speaking with Dr. Brenner and Dr. Agrawal about their recent study, "COVID-19 Outcomes Among Racial and Ethnic Minority Individuals with Inflammatory Bowel Disease in the United States."

Dr. Erica Brenner:  Thank you so much for having us. I am Erica Brenner. I just completed my pediatric gastroenterology fellowship at the University of North Carolina and now I'm starting an inflammatory bowel-disease-specific fellowship.

Me and Dr. Agrawal are part of the core group who founded the SECURE-IBD registry, which is a registry specifically designed to evaluate COVID-19 outcomes among patients with inflammatory bowel disease.

Today, we'll be talking about a study we did evaluating COVID-19 outcomes specifically among racial and ethnic minority individuals with inflammatory bowel disease and talking a little bit about some disparities that we found.

Dr. Manasi Agrawal:  I'm Manasi Agrawal. I'm an assistant professor in medicine in the Division of Gastroenterology at the Icahn School of Medicine at Mount Sinai in New York and my focus is also in inflammatory bowel diseases.

As Erica mentioned, we're a part of SECURE-IBD which is this really great resource that has been tremendously helpful in identifying the impact of COVID-19 in our IBD patients and also assessing the safety of different IBD medications and their impact.

Yes, we were very excited to do this study together to identify what other demographic variables specifically pertaining to recent ethnicity impact COVID-19 outcomes in IBD patients.

AP:  Sounds great. Thank you both so much for joining us today. I'm excited to talk to you a bit about your study. You state that the purpose of your study was to evaluate racial and ethnic disparities in COVID-19 outcomes among IBD patients and the impact of non-IBD comorbidities on observed disparities. What specific disparities did you observe?

Dr. Brenner:  We found that compared to non-Hispanic White individuals, Hispanic patients with IBD were more likely to be hospitalized and to have severe COVID-19 after we adjusted for factors such as age, sex and IBD disease activity. Also, non-Hispanic Black individuals have higher odds of hospitalization and severe COVID compared to non-Hispanic White individuals after doing some more adjustment.

AP:  What non-IBD comorbidities did you find and how did they affect these disparities?

Dr. Brenner:  We found that many individuals who reported to the SECURE-IBD registry had comorbidities like hypertension, lung disease, diabetes, obesity, and cardiovascular disease and that there was a difference in the relative proportions of individuals affected with these conditions across racial and ethnic groups.

Specifically, we found that a higher proportion of Hispanic and non-Hispanic Black individuals had obesity and diabetes compared with non-Hispanic White individuals, and that compared to both non-Hispanic White and Hispanic individuals, a higher percentage of non-Hispanic Black individuals had both lung disease and had hypertension.

Once we adjusted for all of these comorbidities, we found that the odds of remaining outcomes—hospitalization and severe COVID-19—attenuated in non-Hispanic Black and non-Hispanic individuals but that they didn't disappear completely. This suggested to us that these disparities are only partially explained by these underlying comorbid conditions.

AP:  You mentioned that these underlying comorbid conditions across racial groups contribute to worsening COVID-19 outcomes. What difference did you find in outcomes among various racial groups and ethnic groups? For example, were non-Hispanic Black patients with high blood pressure more likely to require hospitalization than White patients with similar comorbidities?

Dr. Brenner:  Yeah, we largely controlled for different comorbidities observed overall in our fully adjusted model. Instead of specifically looking at the extent to which each individual comorbidity includes the likelihood of adverse COVID outcomes, our main goal was to look at really the disparities across the different racial and ethnic groups.

However, we used a technique called backward selection for our fully adjusted model. When we used backward selection, we found that both obesity and lung disease stayed in our model while other comorbidities fell out indicating that these comorbidities specifically had an important influence. That is really consistent with CDC data as well.

AP:  Did the types of treatment these patients received for IBD had an effect on their COVID-19 outcomes?

Dr. Agrawal:  This is a really great question. Yes, we did look at the impact of IBD treatments on the results that we had, and we adjusted for different classes of IBD medications. We adjusted for corticosteroid use, anti-TNF, thiopurines, 5-aminosalicylates and other IBD medications.

Interestingly, we did not find that these medications contributed to a significant difference. We ran models with and without these medications and the results that we got were fairly similar, meaning that IBD medications per se did not have an impact on COVID-19 outcomes based on racial and ethnic categories.

AP:  You concluded that your research highlighted the need for state health policies to bridge gaps in healthcare and improve access and outcomes for all. What would you suggest clinicians do in practice to begin to bridge these gaps? Where can health care professionals start?

Dr. Agrawal:  Yeah, we can all do our little bit at every level. As gastroenterologists and health care professionals, we can start by recognizing in our practice that minority groups are especially vulnerable to adverse outcomes and keep that in mind and adjust our practice accordingly.

In addition, at an individual patient level, if we are able to identify the barriers experienced by each patient by something, perhaps, as simple as asking them about it, perhaps there may be a way that we can provide solutions for patients to overcome those barriers, or even the patients may be able to recognize those barriers better and address them. Just by doing so, we may be able to help improve care for these patients.

Dr. Brenner:  I completely agree with Manasi. I think that the first step is identifying the gaps. I think that is why we felt that this research was so important. The next step is talking to patients and especially talking to minority individuals affected by these disparities and hearing straight from them how we can bridge these gaps.

AP:  Great advice. Thank you, both. What are the key takeaways for practicing gastroenterologists from your research?

Dr. Agrawal:  We think that the key takeaways for practicing gastroenterologists based on our research are that race and ethnicity are very important determinants of health and minority groups with IBD have worse COVID-19 outcomes, and this in part is due to underlying comorbid conditions.

There have been some excellent studies on the topic that have been conducted in the past. Upon review of their data and putting it together with what we found, we think that limited access to health care, economic and educational disadvantage and disparities, and social determinants of health contribute directly to worse COVID-19 outcomes and indirectly through a higher prevalence of comorbid conditions.

Again, at an individual practice level, keeping this in mind, identifying that minority groups are more likely to be vulnerable to adverse health outcomes is a first step towards equitable access of health care for all and just improving outcomes in general.

AP:  Those are great takeaways. Thank you so much. Do you two have anything else you'd like to share with our listeners, maybe another study that you're working on or anything interesting you would like to discuss a little further?

Dr. Brenner:  What I would like to underscore is the reason that we felt it was important to do the study specifically in the inflammatory bowel disease population because a lot of other really important studies have indicated that racial and ethnic minority groups have worse COVID-19 outcomes than overall in the general population.

We also know that specifically among individuals with inflammatory bowel disease, some research had found that minority individuals have worse IBD specific outcomes like hospitalization and surgery. That's why we had this concern that this might be a double whammy situation where minority individuals both with inflammatory bowel disease tend to have disparities and then in terms of COVID-19 outcomes.

I think our results are consistent with that and just highlights the need for a lot of the important work that Dr. Agrawal talked about.

AP:  Definitely. Thank you both so much again for taking time to do this really great insight, a lot of good information. I think our readers are going to get a lot of it and be very interested to check out your study. Thank you again for taking your time.

Dr. Brenner:  Thank you again for having us.

Dr. Agrawal:  Thank you for having us.