Hispanic Ethnicity is Associated With Milder Disease Severity in Crohn’s Disease but not Ulcerative Colitis

Abstract

Introduction: Inflammatory bowel disease (IBD) is increasing among Hispanic patients; however few studies have examined differences in epidemiology, disease severity, and treatment course between Hispanic and non-Hispanic patients. Our aim was to evaluate ethnicity as a clinically significant variable influencing disease severity, need for anti-TNF ±immunomodulator therapy, rates of surgery, and hospitalizations. Methods: A cohort of adult IBD patients followed in a large urban safety-net hospital between January 2007 and December 2012 was identified. The following variables were extracted from the electronic medical record: age, gender, race/ethnicity, disease type and severity, treatment regimens, steroid-free remission at 26 weeks, receipt of IBD-related surgery, and hospitalizations. Fisher exact and Mann-Whitney rank sum tests were used to compare categorical and continuous variables between Hispanic and non-Hispanic patients respectively. Results: We identified a total of 291 adult IBD patients, including 148 with Crohn’s Disease (CD), and 143 with ulcerative colitis (UC). Our cohort was 54% male and median age was 44 years. Our cohort was racially diverse with 32% white, 37% black, 28% Hispanic, and 2% Asian. Hispanic patients appeared to have a more benign disease course, with significantly less IBD-related surgeries (mean 0.4 vs. 1.1; p=0.001) and total hospitalizations (mean 2.1 vs. 2.9; p=0.04). Treatment regimens were significantly different between Hispanics and non-Hispanics (p=0.04), as Hispanic patients were less likely to require anti-TNF ± immunomodulator therapy (27% vs. 39%). On subgroup analysis, these differences were primarily noted among those with CD but not those with UC. Hispanic UC patients had a similar number of IBD-related surgeries (p=0.17) and hospitalizations (p=0.62), whereas Hispanic CD had lower rates of both IBD-related surgeries (mean 0.8 vs. 1.8; p=0.01) and total hospitalizations (mean 2.4 vs. 3.8; p=0.04). Hispanic patients with CD also were significantly less likely to require anti-TNF ± immunomodulator therapy (38% vs. 57%; p=0.05). Conclusion: Hispanic CD patients appear to have less severe disease than non-Hispanic patients, with lower rates of IBD-related surgery, hospitalization, and need for anti-TNF therapy. In contrast, Hispanic ethnicity does not appear to be associated with disease course severity in UC patients.