A national survey study led by UCLA Health and Cedars-Sinai Medical Center found significant disparities in how irritable bowel syndrome, or IBS, is diagnosed across sex and racial groups in the U.S., with men and Black patients considerably less likely than women and white patients to receive a formal diagnosis.
IBS is a chronic condition, known as a disorder of gut-brain interaction, which causes symptoms including abdominal pain, bloating, gas, diarrhea and/or constipation. Between 20-40 million Americans are estimated to be affected by the condition.
The new study, published in the journal Clinical Gastroenterology and Hepatology, analyzed responses from more than 88,600 adults who participated in the 2020 National Gastrointestinal Survey II led by Cedars-Sinai Medical Center in Los Angeles. Of those respondents, 6.1% met the Rome IV criteria — the clinical standard used to diagnose IBS — and were included in the analysis.
The study’s senior author, Dr. Lin Chang of UCLA Health, said the study sought to determine whether disparities in healthcare-seeking behavior and diagnosis of IBS existed based on sex, race, and ethnicity among U.S. adults. While there have been similar studies on health care disparities of other gastrointestinal conditions, IBS has remained largely unstudied in this context.
“Going without a diagnosis carries real consequences,” said Chang, chief of the Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA Health. “Patients without a clear IBS diagnosis may face coverage denials for effective therapies. They may also undergo repeated, unnecessary medical tests and emergency department visits as providers search for explanations for unresolved symptoms, an approach which drives up costs without improving outcomes.”
Key findings included:
- 35% of White patients received an IBS diagnosis vs. 24.6% of Black patients
- Hispanic respondents received an IBS diagnosis (25.6%) less often than non-Hispanics (34%)
- More women received a diagnosis of IBS (36.5%) compared to men (26.2%)
- Women were more likely to seek health care for symptoms compared to men (73.3% vs 68.7%)
- Healthcare-seeking behavior was similar across all racial and ethnic groups
- At least two-thirds of all survey respondents met IBS symptom-based diagnostic criteria but had not received a formal IBS diagnosis
One of the more striking findings was that Black respondents were less likely to receive an IBS diagnosis than white respondents, despite similar reported healthcare-seeking behavior and symptom severity, socioeconomic status and provider type.
Chang said the racial disparities observed are consistent with broader patterns of health care inequity documented in other gastrointestinal conditions, including inflammatory bowel disease, colorectal cancer screening and liver disease.
Differences in sex disparities in IBS diagnosis may partly reflect differences in symptom burden and healthcare seeking. Women in the survey reported more severe bloating, constipation and abdominal pain than men and were more likely to seek healthcare.
Social factors that may discourage men from seeking medical attention may also play a role, Chang said, though further study is needed. The gap could also be contributing to an overestimation of how much more common IBS is in women compared to men.
Researchers noted that cultural biases, historical misconceptions about who gets IBS, stigma of IBS being perceived as a less legitimate medical condition and gaps in patient-provider communication may all contribute to lower diagnosis rates among Black patients.
To begin addressing these disparities, the researchers called for clinician education to raise awareness of these disparities, improvements to diagnostic approaches and the development of bias mitigation strategies in clinical training. They also suggested that artificial intelligence tools embedded in electronic health records could help providers proactively identify patients whose symptom patterns are consistent with IBS, potentially reducing diagnostic delays.
“While further research is needed, our findings underscore the need for greater provider awareness and more equitable approaches to IBS care and diagnosis,” Chang said.
The study's authors acknowledged several limitations, including unequal sample sizes across demographic groups, the survey's English-only format and reliance on self-reported diagnoses rather than medical record verification.
