African Americans Have More Severe Disease at Presentation Among Adults With Crohnʼs Disease, and Asians Have More Severe Disease at Presentation Among Adults With Ulcerative Colitis

Abstract

Introduction: Severity of disease at presentation among adults with inflammatory bowel disease (IBD) affects disease progression and treatment options. While IBD is well studied in Caucasians, IBD epidemiology is less well studied among ethnic minorities. Disparities in severity of disease at presentation may reflect delayed diagnoses or barriers in access to specialty care, challenges that may affect underserved safety-net populations to a greater extent. Our study evaluates ethnic disparities in severity of disease at presentation among adults with IBD in a diverse urban community-based healthcare system. Methods: All consecutive adults with IBD seen in the gastroenterology clinics of a community-based safety-net hospital from July 2014 to October 2016 were retrospectively evaluated to compare race/ethnicity-specific disparities in severity of disease at presentation. Disease severity in patients with Crohn's disease (CD) was evaluated with the Crohn's Disease Activity Index (CDAI) and the Harvey-Bradshaw Index (HBI). Disease severity in adults with ulcerative colitis (UC) was evaluated using the Simple Clinical Colitis Activity Index (SCCAI) and the Mayo score. Race/ethnicity-specific comparisons of disease activity scores utilized Student's t-test.Table: Table. Race/Ethnicity Disparities in SCCAI Scores at PresentationTable: Table. Race/Ethnicity Disparities in HBI Scores at PresentationResults: Of 157 IBD patients, 59 had CD (54.2% male, mean age 38.2, 42.3% African American, 22.0% Caucasian, 20.3% Hispanic and 8.5% Asian) and 98 had UC (56.1% male, mean age 40.1, 31.0% African American, 29.8% Hispanic, 17.9% Asian, 19.1% Caucasian). For CD patients, the mean HBI score was 6.4 (SD 4.1) and the mean CDAI score was 118.4 (SD 74.6). HBI scores were higher in African Americans vs Hispanics (7.6 vs. 4.2, p=0.037). There was also a trend toward higher CDAI scores in African Americans. In UC patients the mean Mayo score was 6.6 (SD 3.1) and the mean SCCAI score was 6.49 (SD 4.0). Stratified by race/ethnicity, mean SCCAI scores were higher in non-Caucasians vs Caucasians (7.0 vs. 5.4, p=0.03) and in Asians vs Caucasians (8.0 vs. 4.6, p=0.02), and Hispanics trended toward higher mean SCCAI scores vs Caucasians (6.9 vs. 4.6, p=0.08). Similar trends were observed in the Mayo scores with more severe disease in Asians. Conclusion: In adults with IBD at an ethnically diverse safety-net hospital system, significant race/ethnicity-specific disparities in disease severity at presentation were observed. African Americans with CD presented with the most severe disease and Asians with UC presented with the most severe disease.