Characteristics of Anemia and Inflammatory Bowel Disease (IBD) Activity in African American versus Caucasian Patients: An Experience at an Urban Tertiary Referral IBD Center From 2008-2018

Abstract

Introduction: Anemia is a common extra-intestinal complication of inflammatory bowel disease (IBD). Epidemiologic studies of United States IBD patients are limited. Our study compares the features of anemia as well as disease activity in African American (AA) and Caucasian IBD patients at an urban tertiary referral IBD center.2805 Figure 1. Patient demographics, disease characteristics, anemia features, and healthcare utilization statistics (a) definition of anemia: men with Hb <13 g/dL, in nonpregnant women <12 g/dL, in pregnant women <11 g/dL. (b) Mild anemia (Hb 11-13 g/dL in male and 11-12 g/dL in female), moderate anemia (Hb 8-11 g/dL in both sex) and severe anemia (Hb <8 g/dL in both sex).Methods: Inpatient and outpatient charts of IBD patients presenting from 2008-2018 to an inner-city tertiary referral center were reviewed for: clinical data, labs, endoscopy, imaging, surgery and IBD medication use. WHO criteria defined severity of anemia. Iron deficiency was defined as a ferritin Results: A total of 278 patients were included in the analysis. Sixty patients (21.5%) were African American, 183 patients (66%) were Caucasian, and 35 patients (12.5%) were neither. Anemia characteristics, IBD demographics, and disease activity were compared between AA and Caucasian population. (Table 1) AA population had a greater proportion of anemic patients compared to Caucasian population during the follow up duration (63% vs 48%, p 0.04). However, there was no statistical difference in iron supplementation between the two groups (38% vs 30%, p 0.2). AA patients were noted to have more active disease compared to Caucasian patients during the time of their lowest hemoglobin level. (Active disease on endoscopy or imaging 70% vs 55%, p 0.04 and higher ESR value 22.5 vs 13 mm/hr, p 0.004). AAs were likely to require more all-cause hospital admissions compared to Caucasian patients (63% vs 48%, p 0.04). There was no significant difference in usage of biologics or immunomodulators. Conclusion: In our study, AA patients demonstrated more active disease as well as higher prevalence of anemia subsequently requiring more hospital admissions compared to the Caucasian population. However, there was no difference in IBD as well as anemia management between these two groups. Underlying etiology of these findings requires further research but our study emphasizes the need for closer monitoring and treatment of AA patients with IBD.