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Meta-Analysis
. 2024 Jun 24;13(1):164.
doi: 10.1186/s13643-024-02584-3.

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

Nathalie Fogh Rasmussen  1   2 , Caroline Moos  3 , Laura Helene Keiding Gregersen  4 , Zainab Hikmat  4   5 , Vibeke Andersen  4 , Anders Green  6 , Tine Jess  7   8 , Gunvor Iben Madsen  9 , Andreas Kristian Pedersen  3 , Sofie Ronja Petersen  3 , Lene Juel Kjeldsen  10
Affiliations
Meta-Analysis

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

Nathalie Fogh Rasmussen et al. Syst Rev. .

Abstract

Background: Inflammatory bowel diseases (IBDs) are associated with high healthcare utilization. This systematic review aimed to summarize what is known about the impact of sex, income, and education on the likelihood 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 the likelihood of surgery and hospitalization. In addition, we performed subgroup analyses of the effect of IBD type (Crohn's disease or ulcerative colitis) and age. Finally, meta-regression was undertaken for the year of publication.

Results: In total, 67 studies were included, of which 23 studies were eligible for meta-analysis. In the main meta-analysis, male sex was associated with an increased likelihood of bowel surgery (HR 1.42 (95% CI 1.13;1.78), which was consistent with the subgroup analysis for UC only (HR 1.78, 95% CI 1.16; 2.72). Sex did not impact the likelihood of hospitalization (OR 1.05 (95% CI 0.86;1.30), although the subgroup analysis revealed an increased likelihood of hospitalization in CD patients (OR 1.42, 95% CI 1.28;1.58). In 9 of 10 studies, no significant sex-based differences in the use of biologics were reported, although in 6 of 6 studies, female patients had lower adherence to biologics. In 11 of 13 studies, no significant sex-based difference in the use of corticosteroids was reported. The evidence of the impact of income and education on healthcare utilization was sparse and pointed in different directions. The substantial heterogeneity between studies was explained, in part, by differences in IBD type and age.

Conclusions: The results of this systematic review indicate that male patients with IBD are significantly more likely to have surgery than female patients with IBD but are not, overall, more likely to be hospitalized, 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 healthcare utilization. Evidence for income- and education-based differences remains sparse.

Systematic review registration: PROSPERO CRD42022315788.

Keywords: Hospitalization; Inflammatory bowel disease; Sex differences; Socioeconomic differences; Surgery.

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Conflict of interest statement

TJ reports consulting for Ferring and Pfizer. All other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA 2020 flow diagram. From: Page M J, McKenzie J E, Bossuyt P M, Boutron I, Hoffmann T C, Mulrow C D et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews BMJ 2021; 372:n71 doi:10.1136/bmj.n71
Fig. 2
Fig. 2
Forest plot of RE model meta-analysis of HRs for the likelihood of surgery across included studies Forest plot of RE model meta-analysis of HRs for the likelihood of surgery in male patients compared to female patients with IBD across included studies. Reference: female patients. Abbreviations: HR, hazard ratio; IBD, inflammatory bowel disease; NA, not applicable; RE, random effects
Fig. 3
Fig. 3
Forest plot of subgroup (CD/UC) meta-analysis of HRs for risk of surgery Forest plot of RE model subgroup meta-analysis of HRs for risk of surgery in male patients compared to female patients with IBD by IBD subtype. Reference: female patients. Abbreviations: HR, hazard ratio; IBD, inflammatory bowel disease; NA, not applicable; RE, random effects
Fig. 4
Fig. 4
Forest plot of subgroup (children/adults) meta-analysis of HRs for risk of surgery Forest plot of RE model subgroup meta-analysis of HRs for risk of surgery in male patients compared with female patients with IBD by children and adults subgroups. Reference: female patients. Abbreviations: HR, hazard ratio; IBD, inflammatory bowel disease; NA, not applicable; RE, random effects
Fig. 5
Fig. 5
Forest plot of subgroup (country) meta-analysis of HRs for risk of surgery Forest plot of RE model subgroup meta-analysis of HRs for risk of surgery in male patients compared with female patients with IBD by country. Reference: female patients. Abbreviations: HR, hazard ratio; IBD, inflammatory bowel disease; NA, not applicable; RE, random effects
Fig. 6
Fig. 6
Forest plot of RE model meta-analysis of ORs for the likelihood of hospitalization across included studies Forest plot of RE model meta-analysis of ORs for the likelihood of hospitalization in male patients compared to female patients with IBD across included studies. Reference: female patients. Abbreviations: OR, odds ratio; IBD, inflammatory bowel disease; NA, not applicable; RE, random effects
Fig. 7
Fig. 7
Forest plot of subgroup (CD/UC) meta-analysis of ORs for risk of hospitalization Forest plot of RE model subgroup meta-analysis of ORs for risk of hospitalization in male patients compared to female patients with IBD by IBD subtype. Reference: female patients. Abbreviations: OR, odds ratio; IBD, inflammatory bowel disease; NA, not applicable; RE, random effects
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