Significant sex and racial disparities exist in health care-seeking behavior and health care provider-based diagnosis among people with irritable bowel syndrome (IBS), according to a study published online March 25 in Clinical Gastroenterology and Hepatology.
Christopher V. Almario, M.D., from Cedars-Sinai Medical Center in Los Angeles, and colleagues explored sex, race, and ethnic differences in health care-seeking behavior and IBS diagnosis rates among U.S. adults. The analysis included responses from 5,414 participants with IBS in the 2020 U.S. National Gastrointestinal Survey II.
The researchers found that most respondents with IBS were female (63.3 percent), White (79.5 percent), and non-Hispanic (87.4 percent). Just under three-quarters (71.6 percent) reported health care-seeking behavior, which was higher in women (73.3 versus 68.7 percent in men). Just under one-third seeking health care (32.9 percent) received a health care provider-based IBS diagnosis, which was also higher in women than men (36.5 versus 26.2 percent) and in White versus Black/African American respondents (35.0 versus 24.6 percent). Hispanic respondents had a numerically lower rate of health care provider-based IBS diagnosis than non-Hispanic respondents (25.6 versus 34.0 percent).
“Going without a diagnosis carries real consequences,” senior author Lin Chang, M.D., from UCLA Health in Los Angeles, said in a statement. “Patients without a clear IBS diagnosis may face coverage denials for effective therapies. They may also undergo repeated, unnecessary medical tests and emergency department visits as providers search for explanations for unresolved symptoms, an approach which drives up costs without improving outcomes.”
Several authors disclosed ties to the pharmaceutical industry.
Black Americans may be less likely to receive an IBS diagnosis due to a combination of implicit bias from providers, inequities in healthcare access, and cultural stigma surrounding digestive problems. Research also shows that Black patients were less likely to receive referrals to dietitians within one year following their IBS diagnosis and may have lower rates of receiving personalized management plans.
When IBS is underdiagnosed or misdiagnosed, patients may undergo repeated imaging, colonoscopies, or emergency department visits before the necessary treatment is initiated.
Delayed diagnosis and treatment can contribute to prolonged, worsening symptoms, increased psychological distress, and reduced quality of life. Research suggests that some patients can experience symptoms for up to five years before receiving a formal diagnosis.
As previously mentioned, without an accurate diagnosis, many patients may undergo extensive and unnecessary diagnostic testing, increasing healthcare utilization and the overall economic burden.
In addition to the physical burden of living with unmanaged IBS, many patients may also experience mental health challenges. According to research, up to one-third of people with IBS also experience anxiety or depression. Chronic stress can trigger immune activation and alter gut motility, while mental health conditions can exacerbate gastrointestinal symptoms, reinforcing the gut-brain axis associated with IBS.
Early recognition of IBS symptoms in primary care settings — in addition to timely referral to gastroenterology care when appropriate — may help improve patient outcomes and reduce unnecessary testing.
The study’s findings underscore the need for earlier recognition and diagnosis of IBS in Black patients. Although addressing these disparities in diagnosis and treatment will require systems-level change, providers can take practical steps to improve care delivery and patient outcomes.
Strategies providers can implement include:
Black men continue to face disparities in IBS care due to factors such as delayed diagnosis and treatment, cultural stigma, and healthcare access inequities. The latest research shows that early recognition and treatment will be necessary to improve outcomes for this patient population.
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