Period of U.S. Immigration Affects Inflammatory Bowel Disease Onset in Cuban Immigrants

Abstract

Introduction: South Florida has received waves of immigrants from Latin America providing the unique opportunity to identify risk factors responsible for the rising inflammatory bowel disease (IBD) incidence among immigrant Hispanics. Cubans comprise the largest immigrant group in Miami and have arrived in the US in distinct waves. We sought to determine whether IBD onset differed within Cubans in Miami stratified by period of immigration into the US. Methods: We performed a prospective study on adult patients who had IBD and were followed in our GI clinic. Cuban patients were identified and demographic information including year of immigration and age of immigration was obtained. We recorded information on age of IBD symptom onset and duration of disease. Age of IBD onset was compared among Cubans according to categorical periods of immigration using ANOVA and Student's t-test. Categorical periods of immigration reflected socio-political waves of migration into the US (before 1959, 1960s-1979s, 1980-1994, 1995 to present). Linear regression analysis with duration in the US as an independent variable was performed to analyze for onset of IBD from time of immigration. Results: A total of 234 patients were analyzed: 172 foreign-born Cubans and 62 US born first generation Cubans. A total of 138 foreign-born Cubans developed IBD symptoms after US immigration. Of these, age of IBD symptom onset was younger in Cubans immigrating after 1980 than before 1979, despite adjusting for age of immigration (45 yrs vs 29.75 yrs, respectively; p < 0.00001). US born Cubans had a similar younger age of onset as later periods of immigration compared to patients who immigrated prior to 1980 (19.50 yrs US born Cubans vs 31 foreign-born Cubans immigrating after 1980 vs 45 yrs foreign-born Cubans immigrating prior to 1975, p < 0.001). There was no difference in age of IBD onset by period of immigration in patients who developed IBD symptoms in Cuba. Conclusion: There is a temporal relationship between IBD development and immigration period in immigrant Hispanics coming to the US. IBD occurs within a shorter period of time from immigration in later waves of Cuban immigrants. This finding may be explained by changing environmental exposures present within the US. The study of IBD in migrant Hispanic populations may further our understanding of evolving environmental triggers responsible for the rise in IBD in developing countries.Figure 1