Clinical Presentation and Disease Course of Inflammatory Bowel Disease Differs by Race in a Large Tertiary Care Hospital
- 370 Downloads
- 12 Citations
Abstract
Background
While the incidence of inflammatory bowel disease (IBD) among African-Americans (AAs) is increasing, there is limited understanding of phenotypic differences and outcomes by race.
Aim
To describe disease characteristics of AA patients compared to Caucasian (Ca) patients in a tertiary care population.
Methods
We performed a cross-sectional review of the IBD registry at the University of Chicago from January 2008 to January 2013. Data regarding race, phenotype, disease onset, disease duration, medical therapy, and surgical treatment were abstracted from the database, then compared via Pearson’s chi-square analysis, Kruskal–Wallis analysis, and logistic regression with a significance level of p < 0.05.
Results
A total of 1,235 patients with Crohn’s disease (CD) and 541 patients with ulcerative colitis (UC) included 108 AA CD patients and 28 AA UC patients. AA CD patients had an increased rate of IBD-related arthralgias (36.5 vs. 23.9 %, p < 0.01) and surgery (p < 0.01), less ileal involvement (57.8 vs. 71.0 %, p < 0.01), and no differences for other extraintestinal manifestations or disease locations compared to Ca CD patients. AA UC patients were older at diagnosis, had an increased rate of arthralgias (28.6 vs. 14.6 %, p = 0.047) and ankylosing spondylitis/sacroiliitis (7.1 vs. 1.6 %, p = 0.035), with no differences for disease extent or rate of IBD-related surgeries compared to Ca UC patients. There were no differences in medication usage by race for CD and UC patients.
Conclusion
We identified significant differences in disease characteristics and extraintestinal manifestations between AA and Ca IBD patients in a large tertiary care population. These results have implications for future genotype-phenotype studies.
Keywords
Ulcerative colitis Crohn’s disease Epidemiology Race African-AmericanAbbreviations
- IBD
Inflammatory bowel disease
- Ca
Caucasian
- AA
African-American
- CD
Crohn’s disease
- UC
Ulcerative colitis
- 5-ASA
5-Aminosalicylate
- IPAA
Ileal pouch-anal anastomosis
Notes
Acknowledgments
Funded in part by the following Grants: P30DK42086 (Digestive Diseases Research Core Center) and K08DK090152 (J.P.).
Conflict of interest
None.
Supplementary material
References
- 1.Malaty HM, Hou JK, Thirumurthi S. Epidemiology of inflammatory bowel disease among an indigent multi-ethnic population in the United States. Clin Exp Gastroenterol. 2010;3:165–170.PubMedCentralPubMedCrossRefGoogle Scholar
- 2.Sewell JL, Yee HF Jr, Inadomi JM. Hospitalizations are increasing among minority patients with Crohn’s disease and ulcerative colitis. Inflamm Bowel Dis. 2010;16:204–207.PubMedCrossRefGoogle Scholar
- 3.Veluswamy H, Suryawala K, Sheth A, et al. African-American inflammatory bowel disease in a southern U.S. Health Center. BMC Gastroenterol Engl. 2010;10:104.CrossRefGoogle Scholar
- 4.Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology. 2004;126:1504–1517.PubMedCrossRefGoogle Scholar
- 5.Ogunbi SO, Ransom JA, Sullivan K, Schoen BT, Gold BD. Inflammatory bowel disease in african-american children living in Georgia. J Pediatr. 1998;133:103–107.PubMedCrossRefGoogle Scholar
- 6.Simsek H, Schuman BM. Inflammatory bowel disease in 64 black patients: analysis of course, complications, and surgery. J Clin Gastroenterol. 1989;11:294–298.PubMedCrossRefGoogle Scholar
- 7.Basu D, Lopez I, Kulkarni A, Sellin JH. Impact of race and ethnicity on inflammatory bowel disease. Am J Gastroenterol. 2005;100:2254–2261.PubMedCrossRefGoogle Scholar
- 8.Nguyen GC, Torres EA, Regueiro M, et al. Inflammatory bowel disease characteristics among African Americans, Hispanics, and Non-Hispanic Whites: characterization of a large North American cohort. Am J Gastroenterol. 2006;101:1012–1023.PubMedCrossRefGoogle Scholar
- 9.Mahid SS, Mulhall AM, Gholson RD, Eichenberger MR, Galandiuk S. Inflammatory bowel disease and African Americans: a systematic review. Inflamm Bowel Dis. 2008;14:960–967.PubMedCrossRefGoogle Scholar
- 10.Deveaux PG, Kimberling J, Galandiuk S. Crohn’s disease: presentation and severity compared between black patients and white patients. Dis Colon Rectum. 2005;48:1404–1409.PubMedCrossRefGoogle Scholar
- 11.Jackson JF III, Dhere T T, Repaka A, Shaukat A, Sitaraman S. Crohn’s disease in an African-American population. Am J Med Sci. 2008;336:389–392.PubMedCrossRefGoogle Scholar
- 12.Moore L, Gaffney K, Lopez R, Shen B. Comparison of the natural history of ulcerative colitis in African Americans and Non-Hispanic Caucasians: a historical cohort study. Inflamm Bowel Dis. 2012;18:743–749.PubMedCrossRefGoogle Scholar
- 13.Sewell JL, Inadomi JM, Yee HF Jr. Race and inflammatory bowel disease in an urban healthcare system. Dig Dis Sci. 2010;55:3479–3487.PubMedCentralPubMedCrossRefGoogle Scholar
- 14.Straus WL, Eisen GM, Sandler RS, Murray SC, Sessions JT. Crohn’s disease: does race matter? The mid-atlantic Crohn’s disease study group. Am J Gastroenterol. 2000;95:479–483.PubMedCrossRefGoogle Scholar
- 15.Nguyen GC, LaVeist TA, Harris ML, Wang MH, Datta LW, Brant SR. Racial disparities in utilization of specialist care and medications in inflammatory bowel disease. Am J Gastroenterol. 2010;105:2202–2208.PubMedCentralPubMedCrossRefGoogle Scholar
- 16.Schaefer ME, Machan JT, Kawatu D, et al. Factors that determine risk for surgery in pediatric patients with Crohn’s disease. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2010;8:789–794.Google Scholar
- 17.Nguyen GC, Bayless TM, Powe NR, Laveist TA, Brant SR. Race and health insurance are predictors of hospitalized Crohn’s disease patients undergoing bowel resection. Inflamm Bowel Dis. 2007;13:1408–1416.PubMedCrossRefGoogle Scholar
- 18.White JM, O’Connor S, Winter HS, et al. Inflammatory bowel disease in African American children compared with other racial/ethnic groups in a multicenter registry. Clin Gastroenterol Hepatol. 2008;6:1361–1369.PubMedCentralPubMedCrossRefGoogle Scholar
- 19.Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the third national health and nutrition examination survey 1991–94. J Rheumatol. 2006;33:2271–2279.PubMedGoogle Scholar
- 20.Eidelwein AP, Thompson R, Fiorino K, Abadom V, Oliva-Hemker M. Disease presentation and clinical course in black and white children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2007;44:555–560.PubMedCrossRefGoogle Scholar
- 21.Jostins L, Ripke S, Weersma RK, et al. Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease. Nature. 2012;491:119–124.PubMedCentralPubMedCrossRefGoogle Scholar
- 22.Anderson CA, Boucher G, Lees CW, et al. Meta-analysis identifies 29 additional ulcerative colitis risk loci, increasing the number of confirmed associations to 47. Nat Genet. 2011;43:246–252.PubMedCentralPubMedCrossRefGoogle Scholar
- 23.Franke A, McGovern DP, Barrett JC, et al. Genome-wide meta-analysis increases to 71 the number of confirmed Crohn’s disease susceptibility loci. Nat Genet. 2010;42:1118–1125.PubMedCentralPubMedCrossRefGoogle Scholar
- 24.Fujimura JH, Rajagopalan R. Different differences: the use of ‘genetic ancestry’ versus race in biomedical human genetic research. Soc Stud Sci. 2011;41:5–30.PubMedCentralPubMedCrossRefGoogle Scholar
- 25.Torres JB, Kittles RA. The relationship between “race” and genetics in biomedical research. Curr Hypertens Rep. 2007;9:196–201.PubMedCrossRefGoogle Scholar
- 26.Collier R. Race and genetics in the doctor’s office. Can Med Assoc J. 2012;184:752–753.CrossRefGoogle Scholar