Patient race and disease type may have a role in vitamin D levels in IBD patients

Abstract

It is reported that African Americans have lower vitamin D levels than other racial subgroups in the United States. Additionally, inflammatory bowel disease (IBD) is associated with an increased prevalence of vitamin D deficiency. There are limited studies evaluating vitamin D levels in African Americans with IBD. This study assessed the impact of patient race upon vitamin D levels and supplementation in patients managed in an IBD program at an urban university medical center. Medical records of IBD patients seen at a university gastroenterology practice during a 5 year period were evaluated. Patient age, gender, race, disease type (Ulcerative colitis or Crohn's), and most recent vitamin D level were recorded. A database was created using Microsoft Excel. Analysis was performed using Fisher Exact test and t test with significance set at p<0.05. Medical records of 356 patients with IBD were reviewed. There were 217 (61%) females and 139 (39%) males with mean age of 41.7 years. 196 (54.7%) had Crohn's, 158 (44%) had ulcerative colitis, and 2 (1%) had indeterminate disease. There were 198 (55.6%) Caucasians, 97 (27.2%) African Americans, 9 Asians (2.5%), 1 (0.3%) Hispanic, 1 (0.3%) Hawaiian, 2 (0.6%) other, and 48 (13.5%) of unknown race. The limited number of patients enabled analysis to be performed only between Caucasians and African Americans. 178 (50%) patients (114 females, 64 males) had recorded vitamin D levels. 99 (55.6%) patients with Crohn's and 79 (44.4%) patients with ulcerative colitis had vitamin D checked. 97 (54.5%) Caucasians and 47 (26.4%) African Americans had vitamin D levels tested. 97 of 198 (48.9%) Caucasians and 47 of 97 (48.5%) African Americans had vitamin D levels recorded. There was no significant difference in vitamin D screening between Caucasians and African Americans (p=1.0). Of the 97 Caucasians, there were 53 (54.6%) patients with Crohn's and 44 (45.5%) patients with ulcerative colitis. Of the 47 African Americans, 26 (55.3%) patients had Crohn's and 21 (44.7%) patients had ulcerative colitis. The mean vitamin D level was 29.53 ng/ml in Caucasians with Crohn's and 33.29 ng/ml in Caucasians with ulcerative colitis. The average vitamin D level was 24.26 ng/ml in African Americans with Crohn's and 24.19 ng/ml in African Americans with ulcerative colitis. The difference in vitamin D levels between Caucasians and African Americans with Crohn's disease was not significant (p= 0.1208). The difference in vitamin D levels between Caucasians and African Americans with ulcerative colitis was significant (p=0.0086). This study revealed that physicians inconsistently evaluated vitamin D levels in all IBD patients. African Americans with ulcerative colitis had significantly lower vitamin D levels when compared to other patients. African Americans and Caucasians with Crohn's disease had equally low vitamin D levels. It is important that all IBD patients be screened for vitamin D deficiency given their increased risk. It is especially important that African Americans with IBD be monitored closely for vitamin D deficiency given their enhanced risk.