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Medically reviewed by Dr. Shani S. Saks, D.O. on August 23, 2023

A recent literature review suggests a significant difference in care delivery and, thus, treatment outcomes between rural and urban patients with inflammatory bowel disease. This difference is mainly attributed to poor access to gastroenterologists. However, there are ways to counter these disparities.

Inflammatory bowel disease (IBD) is a group of chronic and often debilitating gastrointestinal disorders primarily affecting the digestive system. It encompasses two main conditions: Crohn’s disease and ulcerative colitis. Traditionally, these conditions have affected White people more frequently. However, according to a review published in the journal Clinical Gastroenterology and Hepatology, in recent years, these conditions have increasingly affected ethnic minorities. People from ethnic minorities are more likely to live in underserved areas, such as rural areas.

To date, there have been very few studies regarding the role of geographical disparities on outcomes in IBD patients. Nonetheless, CDC data indicates that age-adjusted mortality rates due to gastrointestinal cancers are four-fold higher in rural areas.

Similarly, studies in the Saskatchewan region of Canada show that patients living with IBD in rural areas are less likely to see gastroenterologists than those in urban areas. Hence, people living in rural areas were at greater hospitalization risk.

Though there are few studies on the subject, several of the studies that have been done show some of the challenges people living in rural areas face.

Delays in Diagnosis Lead to Disease Progression

One study that included multiple sites in Canada and the US showed that, in a population of Crohn’s disease patients with pediatric onset, Black and mixed-race patients constituted about 12% of patients with an inflammatory phenotype. However, complications like stricturing and penetrating disease were disproportionately high in these population groups, at 17% and 38%, respectively, as they are more likely to live in rural communities and experience delays in diagnosis and treatment.

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Limited Utility of Telemedicine

Since the outbreak of COVID-19, telemedicine has gained significant attention. However, there are significant disparities in digital access among urban and rural households. Hence, studies suggest that telemedicine may instead increase these existing disparities. Moreover, vulnerable populations like older adults and Black patients have even lower access to telemedicine.

Lack of Access to Novel Therapies

Another issue contributing to health disparities is the lack of access to novel therapies. Living in disadvantaged and rural areas means having a lower likelihood of participating in clinical studies as well as incurring higher travel costs. This also leaves ethnic minorities and those living in rural areas at a distinct disadvantage.

Possible Ways of Addressing Geographical Disparitiesf

There could be multiple ways to counter these disparities, such as by ensuring early diagnosis of IBD. This may also mean increasing the primary healthcare workforce in rural areas and improving access to education. 

Additionally, there is a need to develop novel ways to identify disease progression in IBD patients. For example, developing better remote monitoring tools.

Further, the authors also propose a need to enhance the value of clinical visits in rural areas. For example, providing better point-of-care tools like intestinal ultrasound during visits. Additionally, there is a need to improve the implementation of telemedicine, digital access, and clinical trials.


Deepak, P., Barnes, E. L., & Shaukat, A. (2023b). Health Disparities in inflammatory bowel disease care Driven by Rural versus Urban Residence: Challenges and Potential solutions. Clinical Gastroenterology and Hepatology, 21(7), 1681–1686. https://doi.org/10.1016/j.cgh.2023.04.006