The Effects of Social Determinants of Health on Medication Utilization in Patients with Inflammatory Bowel Disease

Introduction: Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), are chronic inflammatory conditions requiring ongoing medical management. Although disparities in outcomes across racial and ethnic groups have been reported—particularly higher rates of complications and surgeries in minority populations—the influence of social determinants of health (SDOH) on treatment patterns remains less clearly defined. This study investigates how demographic, clinical, and SDOH factors relate to the use of advanced IBD therapies. Methods: We retrospectively reviewed electronic health records of 1,360 adult patients with IBD within a large healthcare system. The primary outcome was initiation of advanced therapies, including anti-TNF agents, anti-integrins, anti-IL-12/23 agents, and small molecules. We evaluated associations with patient characteristics, including age, race, tobacco use, and reported barriers such as financial strain, food insecurity, transportation difficulties, and symptoms of depression. Statistical analyses included descriptive summaries and logistic regression, with p < 0.05 considered statistically significant. Results: Among patients with CD, younger individuals were more likely to receive anti-TNF (p = 0.01) and anti-IL-12/23 therapies (p = 0.04). In UC, younger age was also associated with greater anti-TNF use (p < 0.001). White patients with CD were more frequently prescribed anti-integrins compared to Black patients (p < 0.001). In the UC group, non-smokers were more likely than smokers to receive small molecule therapies (p = 0.028). No statistically significant relationships were observed between SDOH measures and medication utilization in either UC or CD.