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298 Ali et al. | Journal of Clinical and Translational Research 2023; 9(4): 297-307
disease of the Western world; contemporary research highlights the design of NIS and sampling methods is available at https://
an increasing incidence in the Middle East, Asia, and South www.hcup-us.ahrq.gov. The data in NIS are provided using the
America [2]. Despite advances in IBD therapeutics, disparities in International Classification of Diseases (ICD) 9 (before September
care persist across different races and ethnicities. The previous 2015) and 10 (after October 2015) coding systems. The present
research has documented disparities in treatment initiation and retrospective study utilized the NIS database to identify patients
utilization of advanced therapies among different ethnic groups with a primary diagnosis of IBD from January 2009 to December
[3,4]. Furthermore, it is recognized that IBD exhibits gender- 2019. All patients below the age of 18 were excluded. The codes
specific alterations, highlighting the need for targeted care utilized for each variable in this study are outlined in Table S1.
strategies for female patients [5]. Liu et al. further emphasized
the importance of understanding and addressing these disparities 2.2. Outcome measures
to promote health equity among IBD populations [6]. Mental Primary outcomes included the prevalence of common
illnesses, affecting nearly one in five adults in the United States, psychiatric conditions that included generalized anxiety
represent a considerable public health concern [7]. Therefore, disorder (GAD), depression, somatization, bipolar disorder,
it is critical to understand the influence of racial and gender- attention-deficit hyperactivity disorder (ADHD), schizophrenia,
based disparities on the clinical care of IBD patients, particularly schizoaffective disorder, post-traumatic stress disorder (PTSD),
concerning psychiatric comorbidities. and chronic fatigue in IBD patients. Trend analysis for respective
The incidence of psychiatric illnesses has increased among outcomes was also reported to ascertain any time-based shifts.
IBD patients compared to the general population [8-10]. It Secondary outcomes were associations between gender, race, and
can significantly impact disease progression and healthcare psychiatric disorders among hospitalized IBD patients.
utilization [11]. Comorbid depression and anxiety are linked to
poorer clinical outcomes in IBD patients, including higher odds 2.3. Statistical analysis
of emergency room visits and hospitalizations [12]. IBD has been This study utilized Statistical Software for Data Science
independently associated with an increased risk of deliberate self- (STATA) (StataCorp LLC, College Station, TX, USA),
harm and other mental health illnesses [13]. Specific attention version 16.0. The analysis had 0.05 as the threshold for statistical
must be paid to gender-based disparities in the IBD population, as
some studies suggest an association between female gender, active significance, and all P-values were 2-sided. Bivariate analysis was
IBD, and the onset of depression [14]. Therefore, early detection conducted using a Chi-square test for categorical variables and an
and treatment of psychiatric disorders in the IBD population independent-samples t-test for continuous variables. Categorical
may become vital components of clinical management. It may variables were presented as frequency (N) and percentage (%),
have crucial clinical importance regarding disease progression, and continuous variables were reported as mean with standard
treatment compliance, and quality of life. deviation (SD), as appropriate. For outcomes such as the length of
Despite the recognized importance of these topics, there is a stay and mean inpatient charges, a hierarchical multivariate linear
lack of large-scale, data-driven studies investigating racial and regression analysis was conducted to adjust patient- or hospital-
gender-based disparities and trends in psychiatric comorbidities level factors. Multivariate logistic regression was conducted
among IBD patients. To the best of our knowledge, this article to assess the relationship between gender, race, and psychiatric
represents the first National Inpatient Sample (NIS)-based conditions among hospitalized patients with IBD. The outcomes
retrospective study, providing a comprehensive evaluation of these were reported as adjusted odds ratios (aOR) with 95% confidence
disparities in common psychiatric conditions among IBD patients intervals (CI) and P-values. The adjusted Wald test was utilized
over a decade. Our findings hold significant clinical implications, to compare slopes of time-based linear regression outcomes and
offering a foundation of data-driven evidence that highlights racial Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) to
and gender-based disparities in psychiatric comorbidities among generate figures.
IBD patients. This work is anticipated to heighten community 2.4. Ethical consideration
awareness, support the establishment of effective psychiatric
screening protocols, and promote timely referrals to mental health The NIS database contains de-identified information for the
professionals. These measures will contribute to improve clinical protection of the privacy of patients, physicians, and hospitals.
care and health outcomes for patients with IBD. Therefore, it did not require institutional review board approval.
Patient consent was also waived, as each hospitalization was
2. Materials and Methods stripped of any patient identifiers.
2.1. Design and data source 3. Results
The NIS is designed by the Agency for Healthcare Research 3.1. Demographic characteristics of study sample
and Quality [15]. It is the largest inpatient database in the United
States [15]. The design of this particular database is to approximate The total IBD hospitalizations decreased from
a 20% stratified sample of hospitals along with sampling weights 75,813 (200/100,000 total NIS hospitalizations) in 2009 to
to calculate national estimates [15]. Additional information on 70,210 (198/100,000 total NIS hospitalizations) in 2019, without
DOI: http://dx.doi.org/10.18053/jctres.09.202304.22-00231