Age, Rather Than Social Vulnerability, Is Associated With Disparities in Prescription Patterns in Inflammatory Bowel Disease: An Epic Cosmos Study.

BACKGROUND AND AIMS: Advanced therapies have transformed the management of inflammatory bowel disease (IBD), yet disparities in their use remain poorly characterized. This study aims to describe nationwide patterns of IBD medication exposure and examine associations with demographic, social, and geographic factors using a newly available, large electronic health records based database. METHODS: A retrospective study was conducted using Epic Cosmos, an electronic health record database representing 300 million lives. Patients with more than 1 International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code for Crohn's disease or ulcerative colitis between 2015 and 2024 were included. Descriptive statistics and demographic distribution were studied for all variables. Multivariate regression compared the exposure odds of IBD-specific medications. RESULTS: Our study included 60,187 patients that met criteria. Overall, 43.60% of patients with IBD were exposed to advanced therapies over the timeframe studied. Consistent with prior literature, patients >25 years were less likely to receive anti-interleukin-23/23 biologics, immunomodulators, and Janus kinase inhibitors. Medicare patients were less likely to receive immunomodulators (odds ratio 0.81, 95% confidence interval [0.69, 0.96], P = .016) and 5-aminosalicylic acids (odds ratio 0.83, 95% confidence interval [0.75, 0.92], P < .001). Few racial and ethnic differences in drug exposure were noted. Small racial and ethnic differences in IBD medication usage were demonstrated. Social Vulnerability Index, urban-rural differences, and sex did not demonstrate significant disparities in medication use. CONCLUSION: To our knowledge, this is the first study to assess IBD care in Epic Cosmos. Advanced IBD therapies were less likely to be prescribed to older adults. Social Vulnerability Index, sex, and urban-rural differences were not strong predictors of advanced IBD therapy use, highlighting the complexity of SDOH in IBD care.