Gender-Based Differences in the Epidemiology of Inflammatory Bowel Disease in a Predominantly African American Population

Abstract

Introduction: Although Inflammatory Bowel Disease (IBD) is increasing in African American (AA) population, there is a sparsity of information on the epidemiological features of IBD in AA. Since there is a large AA population in our inner-city clinic, we did a study to compare our AA IBD patients to Non-AA patients. Methods: In order to establish a database of IBD patients seen in the GI clinic of a urban medical center, we used ICD-9 codes to identify all patients with a visit between 2011 and 2014 (n= 409). We identified three categories of patients (definitely not IBD (n=233), possibly IBD (n=68) and endoscopically positive IBD (n=109). We required that patients have two visits, one prior to 2015 and one on or after 2015 (n= 97). Data included demographics, endoscopic/histologic findings, details of treatment, and possible measurements to assess disease control. Data was analyzed using JMP 13 software. Results: Of the total 97 patients, 60 had Crohn's disease (CD); 37 had Ulcerative Colitis (UC), most of the patients were AA (75.5 %). There were more females than males for both CD (62 %) and UC(70%). When assessed based on race and disease AA Females were more likely than Non-AA to be represented in the disease class (UC (AAF= 67% vs Non-AAF =42% p=0.008) and CD (AAF=84% vs Non-AAF= 42% p=0.11). Overall, females were diagnosed later than males (mean age - 32.25 vs. 29.97) but it was not statistically significant. CD were more likely to have severe disease at first visit, defined by elevated C-reactive Protein (CRP) than UC (19 vs 6 mg per liter). AA had more active disease at first visit as defined by higher CRP in both CD and UC (CD AA=20 vs Non-AA=11; UC AA= 6.7 vs Non-AA =3.6). Patients with CD were more likely to be on a biologic (42% vs 16% p=0.009) and on combination therapy (63% vs 27% p=0.005). There were no significant differences between either race or gender with respect to treatment. Conclusion: Most patients in this general GI clinic IBD database were AA (76%) and for both CD and UC, there was a higher percentage of AA females with IBD as compared to Non-AA patients. CD patients were more likely to have severe disease as defined by CRP and AA had higher values than Non-AA. CD patients were more likely to be on biologics and combination therapy. While AA were more likely to have elevated CRP at first visit, there were no racial or gender differences in the use of biologics or combination therapy which were both more frequent in CD than UC.