Background: Crohn’s disease and ulcerative colitis are the two primary forms of inflammatory bowel disease (IBD) which are chronic autoimmune conditions that require timely diagnosis and appropriate lifelong management to prevent severe complications and preserve quality of life. Social Determinants of Health (SDOH), including economic stability, healthcare access, and social context, are known to impact chronic disease outcomes, yet their role in IBD remains underexplored.

Methods: Existing studies on the relationship between SDOH and IBD often lack secondary layers of analysis, limiting deeper exploration of the structural or systemic drivers behind disparities in access. To build on this gap, we conducted a cross-sectional analysis using All-Payer Claims Databases (APCD) from the state of New York and the nationally representative Medical Expenditure Panel Survey (MEPS). APCD data was analyzed to assess associations between race, ethnicity, and hospital utilization metrics. MEPS analysis focused on SDOH impacting emergency room usage among IBD patients. We constructed a composite binary variable—“Underserved”—flagging individuals with one or more indicators of structural disadvantage.

Results: Analysis revealed that race had a modest but significant effect on length of stay (p = 0.044), with illness severity exerting a stronger influence (p < 0.001). Race and insurance type both significantly impacted total charges (p < 0.001), while ethnicity was associated with higher emergency and lower elective admissions (p < 0.001), though not with length of stay or cost. In the MEPS dataset, the composite Underserved variable was a statistically significant predictor of ER utilization among IBD patients. Individual components were not significant when entered together into multivariable models, likely due to multicollinearity. These findings suggest that cumulative social disadvantage is more predictive of healthcare access disparities than any single factor alone.

Conclusion: Economic stability and healthcare access emerged as the most influential and frequently co-occurring SDOH domains, particularly in relation to insurance and financial barriers. However, social and cultural drivers remain under examined in the current literature. Our results underscore the need for multidimensional analyses that reflect the compounding effects of disadvantage. Future directions include a geospatial analysis of IBD care access in marginalized populations and development of a public-facing, searchable disparities database to support patient and policymaker decision-making.