Manifestations And Treatments Of Inflammatory Bowel Disease Across Different Races And Ethnicities In An Urban Public Hospital Setting

Background: IBD incidence is increasing worldwide, yet data regarding its manifestations and management across different races and ethnicities remains limited and conflicting. Understanding IBD epidemiology in non-white populations can have significant implications in diagnosing and treating the disease, as well as offer insight into the environmental and heritable underpinnings of ulcerative colitis and Crohn's disease. Similarly, the paucity of data regarding the outcomes between ethnic and racial groups may allow for disparities in healthcare to go unnoticed. The aim of our study was to delineate the similarities and differences in IBD phenotype and management across racial and ethnic groups in patients treated at a large, urban public hospital. Methods: Retrospective clinical data were collected from 248 patients with IBD cared for at a public hospital in New York City from 2002 to 2016. We compared racial/ethnic variations in the frequency of CD and UC, as well as several disease characteristics including: age at diagnosis, time to diagnosis, extra-intestinal manifestations, location and behavior of disease by Montreal classification, IBD-related dysplasia and cancer, and treatments received. Categorical and continuous data were evaluated by chi-square analysis and analysis of variance (ANOVA), respectively, with statistical significance defined as P < 0.05. Results: The 248 patients represented 4 distinct racial/ethnic groups: 84 (33.9%) Hispanic, 67 (27.0%) white, 65 (26.2%) black, and 32 (12.9%) Asian. The overall distribution of IBD subtype was 111 (44.8%) patients with CD, and 137 (55.2%) with UC. Asians had a significant male predominance (84.4%) compared to whites, blacks, and Hispanics (55.2%, 61.5%, and 57.1%, respectively; P = 0.032). There were no significant differences in the age of diagnosis across groups; at the 2 extremes were blacks with a mean age of 32.4 years and Hispanics with a mean age of 35.8 years. The mean time to diagnosis, defined as the year of diagnosis minus the year of symptom onset, demonstrated a trend toward significance (P = 0.057), with the shortest time to diagnosis in whites and Hispanics (0.86 and 0.84 yr, respectively) and the longest time in blacks (2.11 yr). The Montreal classification for CD and UC were similar among groups, and there were no significant differences in the use of IBD medications, such as biologics and steroids, based on race/ethnicity. Conclusions: To our knowledge, this is the largest single-institution study comparing IBD phenotypes across more than 3 ethnic/racial groups. We note a higher prevalence of IBD in males for Asians compared to other races/ethnicities. We did not detect any significant differences in IBD characteristics and management. As our study was conducted at a single academic hospital that provides specialized IBD care for an underserved and multicultural population, we are able to evaluate racial/ethnic differences in IBD epidemiology and treatment while minimizing confounders such as practice variation and socioeconomic status. Further analysis is warranted to assess the impact of environmental factors, such as being foreign-born versus US-born. In addition, examination of larger study populations would allow detection of small differences and differences in uncommon events. We hope to address these questions through further analysis of this ongoing study.