Impact of sex and socioeconomic status on risk of surgery, hospitalization, and use of medications in inflammatory bowel disease: A systematic review and meta-analysis

Abstract

Abstract Background Inflammatory bowel diseases (IBDs) are often associated with high healthcare utilisation. This systematic review aimed to summarize what is known about the impact of sex, income, and education on the risk of bowel surgery, hospitalization and use of corticosteroids and biologics among patients with IBD. Methods We used EMBASE, MEDLINE, CINAHL, and Web of Science to perform a systematic literature search. Pooled hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random effects meta-analysis for the impact of sex on risk of surgery and hospitalization. In addition, we performed subgroup analyses of the effect of IBD type (Crohn’s disease or ulcerative colitis), children or adults, and country. Finally, meta-regression was undertaken for the year of publication. Results In total, 59 studies were included. In the meta-analysis, male sex was associated with an increased risk of bowel surgery in UC patients (HR: 1.78, 95% CI: 1.16;2.72) and an increased risk of hospitalization in CD patients (OR: 1.42, 95% CI: 1.28;1.58). In 6 of 6 studies, female patients had lower adherence to biologics, whereas 9 of 10 studies reported no significant sex-based difference in use of corticosteroids. The evidence of the impact of income and education on all four outcomes was sparse and pointed in different directions. The substantial heterogeneity between studies was explained, in part, by differences in IBD type, age and country. Conclusions Population-based observational studies have revealed that sex influence the surgery rate and risk of hospitalization among IBD patients with more men having surgeries and hospitalizations than women, whereas female patients appear to have statistically significantly lower adherence to biologics compared to male patients. Thus, clinicians should not underestimate the impact of sex on patient outcomes. Evidence for income- and education based differences remains sparse. Systematic review registration: PROSPERO Registration ID: CRD42022315788.