Is Race a Real Issue in Colectomy for Ulcerative Colitis?

In this issue of Clinical Gastroenterology and Hepatology, Nguyen et al¹ have analyzed national colectomy rates for patients with ulcerative colitis and identified significant racial and regional disparities in the United States. Their report contributes to a body of literature that has identified disparities in several areas of health care related to access, interventions, and outcomes. As in the report from Nguyen et al,¹ most of the previous studies have made use of large governmental or private administrative databases. Although the use of a national administrative database provides reliable global information about the delivery of health care in the United States, they are significantly limited in their ability to explain the precise reasons for any observed difference in care. In their discussion, Nguyen et al¹ clearly cite numerous limitations in the use of the governmental administrative database selected and provide some possible explanations for their findings. Unfortunately, they emphasize racial differences without acknowledging that race may be merely a surrogate maker for other more important factors responsible for their observation. Their use of a single database and focus on race provides an all too simplistic analysis for a problem that is undoubtedly more complex than the authors lead the reader to believe. The authors are to be congratulated for taking on this important question. Although a review of all conflicting literature on the subject of health care disparities is beyond the scope of this editorial, I hope to highlight some of the studies that have evaluated this very important issue.