Abstract
BackgroundPrevious studies comparing immigrant ethnic groups and native patients with IBD have yielded clinical and phenotypic differences. To date, no study has focused on the immigrant IBD population in Spain.MethodsProspective, observational, multicenter study comparing cohorts of IBD patients from ENEIDA-registry who were born outside Spain with a cohort of native patients.ResultsWe included 13,524 patients (1,864 immigrant and 11,660 native). The immigrants were younger (45 ± 12 vs. 54 ± 16 years, p < 0.001), had been diagnosed younger (31 ± 12 vs. 36 ± 15 years, p < 0.001), and had a shorter disease duration (14 ± 7 vs. 18 ± 8 years, p < 0.001) than native patients. Family history of IBD (9 vs. 14%, p < 0.001) and smoking (30 vs. 40%, p < 0.001) were more frequent among native patients. The most prevalent ethnic groups among immigrants were Caucasian (41.5%), followed by Latin American (30.8%), Arab (18.3%), and Asian (6.7%). Extraintestinal manifestations, mainly musculoskeletal affections, were more frequent in immigrants (19 vs. 11%, p < 0.001). Use of biologics, mainly anti-TNF, was greater in immigrants (36 vs. 29%, p < 0.001). The risk of having extraintestinal manifestations [OR: 2.23 (1.92–2.58, p < 0.001)] and using biologics [OR: 1.13 (1.0–1.26, p = 0.042)] was independently associated with immigrant status in the multivariate analyses.ConclusionsCompared with native-born patients, first-generation-immigrant IBD patients in Spain were younger at disease onset and showed an increased risk of having extraintestinal manifestations and using biologics. Our study suggests a featured phenotype of immigrant IBD patients in Spain, and constitutes a new landmark in the epidemiological characterization of immigrant IBD populations in Southern Europe.
Highlights
Inflammatory bowel disease (IBD) is a term that covers Crohn’s disease (CD) and ulcerative colitis (UC), which are chronic, progressive and disabling diseases characterized by cycles of remission and relapse
Compared with native-born patients, first-generation-immigrant IBD patients in Spain were younger at disease onset and showed an increased risk of having extraintestinal manifestations and using biologics
Our study suggests a featured phenotype of immigrant IBD patients in Spain, and constitutes a new landmark in the epidemiological characterization of immigrant IBD populations in Southern Europe
Summary
Inflammatory bowel disease (IBD) is a term that covers Crohn’s disease (CD) and ulcerative colitis (UC), which are chronic, progressive and disabling diseases characterized by cycles of remission and relapse. More than 240 IBD-associated risk variants have been identified to date by large genome-wide association studies [3], genetic background seems only to partially explain susceptibility to the disease and in most cases, environmental risk factors are involved in disease onset and progression [4, 5]. Newer epidemiologic studies define IBD as a global disease, suggesting that its incidence either continues to grow steadily or remains stable in western countries while rapidly increasing in developing countries [8], possibly owing to their increasingly westernized lifestyle [9]. Studies carried out among migrants show that they tend to acquire the disease incidence of their adopted country rather than the country of origin, reflecting the importance of the environmental risk factors such as lifestyle, pollution and diet [10,11,12]. No study has focused on the immigrant IBD population in Spain
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