Abstract INTRODUCTION Inflammatory Bowel Disease (IBD) affects over 3 million U.S. adults and continues to rise, creating significant clinical and economic challenges. While disparities are well documented, less is known about how socioeconomic status and insurance coverage shape prevalence and treatment. Using nationally representative data, this study highlights these inequities and their impact on access to care. Addressing them is essential to achieving more equitable outcomes for patients with IBD. Method NHANES 2021-2023 data was used to identify IBD cases through ICD-10 codes. Each case was linked to sociodemographic and insurance information using the unique SEQN identifier. Data were cleaned and analyzed in Microsoft Excel and SPSS, where prevalence was calculated with pivot tables and Chi-square were used to assess statistical significance. RESULTS Analysis of NHANES 2021-2023 data reveals significant disparities in IBD prevalence across gender, ethnicity, and age. Women demonstrated a slightly higher prevalence compared to men (17.2% vs 15.9%, p = 0.045). Ethnic differences were more striking: African Americans (19.2%) and other Hispanic groups (18.1%) experienced the highest prevalence, while Mexican Americans had the lowest (12.9%, p 0.001). Age also emerged as a key role, with highest prevalence in adults aged 30-49 years old (19.0%, p 0.001). IBD prevalence differs significantly by insurance type (p = 0.02). Medicaid recipients alongside children covered by CHIP demonstrated the highest prevalence (20.69%, 17.65%), notably higher than those with private insurance (16.74%). In contrast, Medicare recipients showed one of the lowest prevalence rates (14.83%), similar to the uninsured population (14.67%). Other coverage types, including military (14.46%), state-sponsored (14.63%), and other government insurance (16.12%), also showed lower prevalence compared to Medicaid. These findings reveal persistent social and demographic inequalities in IBD and underscore the need for targeted prevention, early detection, and equitable care. CONCLUSIONS Using NHANES 2021-2023, a nationally representative CDC database, this study provides a robust and contemporary snapshot of IBD across the United States. We identified persistent disparities in prevalence by gender, race/ethnicity, age, income, education, and insurance status. Consistent with prior research (Kitahata et al.; Tracy et al.), lower income and education were linked to worse outcomes and reduced use of advanced therapies. These inequities are further amplified by social determinants such as insurance coverage, food insecurity, financial hardship, and housing instability (Khalessi, Ali et al.). These findings emphasize the urgent need for stronger health policies that expand insurance, improve access, and reduce barriers to ensure more equitable care for people living with IBD.
Nursjamsi et al. (2026) studied this question.