Do Quality of Life, Disease Activity, and Flares Differ by Race in Ulcerative Colitis Over Time?

Abstract

Purpose: Research suggests that racial disparities may exist in the treatment of ulcerative colitis (UC) patients; however this may be due to racial differences in disease activity. Our aim was to assess for racial differences in disease activity, quality of life, and disease flares over time among patients in a tertiary referral practice. Methods: The Inflammatory Bowel Disease Program's Clinical Database prospectively documents demography, Montreal classification, disease-specific quality of life and disease activity for all UC patients at all clinic visits. We identified Caucasian (W) and African American (AA) UC patients seen between 7/1/2004-12/31/2009 with ≥2 scores for the Short Form Inflammatory Bowel Disease Questionnaire (SIBDQ) and the Simple Clinical Colitis Activity Index (SCCAI). Regression analysis assessed for racial differences in SCCAI, SIBDQ scores and flares over time. Results: 145 UC patients met inclusion criteria; 117 (81%) were Caucasian (W) and 28 (19%) were African American (AA).There were no significant racial differences in demographics, smoking status, overall extraintestinal manifestations (EIM), disease location, baseline SCCAI and SIBDQ scores and flares; 14% of AA patients exhibited biliary EIM compared to 2% of W (p=0.01). In year 1, SCCAI scores decrease differentially in W and AA (p=0.06); W SCCAI scores decrease a mean 0.6 pts with each successive visit window (p<0.01 for trend) compared to a mean 0.2 pts in AA (p=0.48 for trend). In year 1, the odds of flare at each successive visit window decreased 23% in W (p=0.003 for trend) but was static in AA; this difference between W and AA trended to statistical significance (p=0.08). After year 1, SCCAI scores increase in W by a mean 0.8 pts at each visit window (p<0.01 for trend) while scores in AA remained static; these trends were not different by race (p=0.19). After year 1, the odds of flare at each successive visit window rose 21% in W (p=0.55 for trend) and 26% in AA (p=0.60 for trend); this was not significantly different by race (p=0.73). SIBDQ scores increase similarly in the first year for W and AA at each successive visit window (mean 2.3 and 1.9 pts, p< 0.01 for both trends), decreasing in subsequent years by a mean 2.8 pts for W (p <0.01 for trend) and 3.4 pts for AA (p=0.14 for trend). There were no racial differences in SIBDQ trends. Conclusion: Significant temporal differences in disease activity scores and flare rates were not found between W and AA in a tertiary referral UC cohort; however a trend to a more vigorous decrease in SCCAI was seen in W compared to AA in the first year. Further investigation is needed to determine whether this represents racial differences in the course of UC. Disclosure: Dr Raymond Cross - Consultation for Abbott Pharmaceuticals, and grants from Centocor and Abbott Pharmaceuticals; Dr Mark Flasar - grant from Procter and Gamble.