Study Reveals Disparities in Inflammatory Bowel Disease Based on Race, Sex, and Immigration Status

Findings showed that IBD phenotype varied by race, although foreign-born participants of all races showed evidence of later onset and milder disease.

Recent research sheds light on significant variations in how inflammatory bowel disease (IBD) affects individuals of different races, sexes, and place of birth.1

Findings from a single-center retrospective review of patients with a diagnosis of IBD—Crohn disease (CD) and ulcerative colitis (UC)—at a diverse, tertiary care, safety-net center in New York showed that certain aspects of IBD characteristics were common in specific races, and foreign-born persons of all races showed evidence of later onset and milder disease.1

“IBD has historically been a disease of Caucasian populations in Europe and North America, but now we’re seeing it among all races and in people all over the globe, so it’s now important to study how it manifests in different groups,” said senior author Lea Ann Chen, MD, assistant professor of medicine and pharmacology, Rutgers Robert Wood Johnson Medical School, in a press release.2

To examine how race/ethnicity and immigration status influence IBD characteristics, treatments, and outcomes, investigators reviewed records from all patients who underwent treatment for IBD at Belleview Hospital in New York City between 1997 and 2017, excluding any patients without a confirmed IBD diagnosis or with insufficient clinical data on IBD history or treatment.1

Chen and coauthors chose to include patients at Belleview Hospital because it “serves predominantly uninsured and underinsured residents, thereby minimizing the impact of socioeconomic and geographic confounders,” they wrote in Gastro Hep Advances.1

“Using logistic regression modeling, we compared disease onset, treatment, and outcomes by race (White, Black, Hispanic, Asian) and immigration status (US-born vs. foreign born),” added investigators.1

FINDINGS

The cohort comprised 577 patients, of whom 29.8% were White, 27.4% Hispanic, 21.7% Black, and 13.0% Asian, according to the results.1

Researchers found that compared to White participants, Black patients were more likely to have CD (odds ratio [OR] 1.75, 95% CI 1.10-2.77) and more likely to have IBD-related intestinal resections (OR 2.49, 95% CI 1.40- 4.50).1

In addition, compared to US-born participants, results showed that foreign-born participants were more likely to be diagnosed with UC (OR 1.77, 95% CI 1.04-3.02). Foreign-born patients were also less likely to be diagnosed before 16 years of age (OR 0.19, 95% CI 0.08-0.41), to have undergone intestinal resections (OR 0.39, 95% CI 0.19-0.83), to have received biologics (OR 0.43, 95% CI 0.25-0.76), or to have had dermatologic manifestations (OR 0.12, 95% CI 0.03-0.41) compared to US-born participants.1

“The differences in IBD behavior identified in our study supports the importance of developing a deeper understanding of the impact of race and immigration on IBD behavior given not only the rise of disease incidence worldwide, but also the increasing patient diversity within many IBD practices,” wrote Chen and colleagues.1

They continued: “Further studies to mechanistically understand the reason for differential IBD risk and presentation in certain races and among immigrant patients may provide new insights into IBD pathogenesis. This can in turn help guide disease prognostication and management in a growing and diversifying IBD patient population.”1

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