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Sex Differences in Treatment Strategies Among Patients With Ulcerative Colitis: A Retrospective Cohort Analysis of Privately Insured Patients

Sceats, Lindsay A. M.D.1; Morris, Arden M. M.D., M.P.H.1; Bundorf, M. Kate Ph.D., M.B.A, M.P.H.2; Park, K.T. M.D., M.S.3; Kin, Cindy M.D., M.S.1

Diseases of the Colon & Rectum: May 2019 - Volume 62 - Issue 5 - p 586-594
doi: 10.1097/DCR.0000000000001342
Original Contribution: Inflammatory Bowel Disease
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BACKGROUND: Sex-based treatment disparities occur in many diseases. Women undergo fewer procedural interventions, and their care is less consistent with guideline-based therapy. There is limited research exploring sex-based differences in ulcerative colitis treatment. We hypothesized that women are less likely to be treated with strategies consistent with long-term disease remission, including surgery and maintenance medications.

OBJECTIVE: The aim of this study was to determine if patient sex is associated with choice of treatment strategy for ulcerative colitis.

DESIGN: This is a retrospective cohort analysis.

SETTING: Data were gathered from a large commercial insurance claims database from 2007 to 2015.

PATIENTS: We identified a cohort of 38,851 patients newly diagnosed with ulcerative colitis, aged 12 to 64 years with at least 1 year of follow-up.

MAIN OUTCOME MEASURES: The primary outcomes measured were the differences between male and female patients in 1) rates and types of index ulcerative colitis operations, 2) rates and types of ulcerative colitis medication prescriptions, and 3) rates of opioid prescriptions.

RESULTS: Men were more likely to undergo surgical treatment for ulcerative colitis (2.94% vs 1.97%, p < 0.001, OR 1.51, p < 0.001). The type of index operation performed did not vary by sex. Men were more likely to undergo treatment with maintenance medications, including biologic (12.4% vs 10.2%, p < 0.001, OR 1.22, p < 0.001), immunomodulatory (16.3% vs 14.9%, p < 0.001, OR 1.08, p = 0.006), and 5-aminosalicylate medications (67.0% vs 63.2%, p < 0.001, OR 1.18, p < 0.001). Women were more likely to undergo treatment with rescue therapies and symptomatic control with corticosteroids (55.5% vs 54.0%, p = 0.002, OR 1.07, p = 0.002) and opioids (50.2% vs 45.9%, p < 0.001, OR 1.17, p < 0.001).

LIMITATIONS: Claims data lack clinical characteristics acting as confounders.

CONCLUSIONS: Men with ulcerative colitis were more likely to undergo treatment consistent with long-term remission or cure, including maintenance medications and definitive surgery. Women were more likely to undergo treatment consistent with short-term symptom management. Further studies to explore underlying mechanisms of sex-related differences in ulcerative colitis treatment strategies and disease trajectories are warranted. See Video Abstract at

1 S-SPIRE Center, Department of Surgery, Stanford University, Stanford, California

2 Stanford University, Department of Health Research and Policy, Stanford, California

3 Inflammatory Bowel Disease Center, Department of Pediatrics (Gastroenterology), Stanford University, Stanford, California

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Funding/Support: Women & Sex Differences in Medicine Seed Grant (Stanford University).

Financial Disclosures: None reported.

E-Poster presentation at the meeting of the American Society of Colon and Rectal Surgeons, May 19 to 23, 2018, Nashville, TN.

Correspondence: Cindy Kin, M.D., M.S., Stanford University, Department of Surgery, 300 Pasteur Dr, H3680K, Stanford, CA 94305. E-mail:

© The ASCRS 2019