RACIAL AND GENDER DISPARITIES IN THE DEVELOPMENT OF CROHN’S DISEASE COMPLICATIONS: A RETROSPECTIVE ANALYSIS

Abstract

Abstract BACKGROUND Crohn’s disease (CD) is a chronic systemic inflammatory disease that most commonly affects the gastrointestinal tract (GI) and is characterized by transmural inflammation. Complications of CD include fistulization, abscess formation, and GI bleed. CD predominantly affects patients with European ancestry, however Black and Hispanic patients have been noted to have phenotypic differences in disease presentation. Gender may also play a role in CD, with some studies suggesting that men develop more severe disease. METHODS Patients with a diagnosis of CD were identified using the 2020 Nationwide Inpatient Sample (NIS). Patients were stratified based on the presence of CD complications which included fistula, abscess, and bleed. Patients with complications were further stratified based on the specific complication. Data were collected regarding age, gender, race, primary insurance, median income, hospital region, hospital bed size, and comorbidities. The relationship between gender, race, and the development of fistula, abscess, or bleed among patients hospitalized with CD was analyzed using multivariate regression analysis. RESULTS A total of 178,279 patients with a diagnosis of CD were included in the study. Of these, 23,889 (13.4%) developed a complication of CD including fistula, abscess, or bleed. Female patients with CD had a statistically significant lower odds of developing a CD complication (aOR 0.79, P < 0.001). Higher odds of developing a complication of CD were seen in Black patients (aOR 1.47, P < 0.001) and Hispanic patients (aOR 1.29, P < 0.001). Black patients with CD had increased odds of developing fistula (aOR 1.35, P < 0.001), abscess (aOR 1.26, P = 0.004), and bleed (aOR 1.60, P < 0.001). Hispanic patients with CD had higher odds of developing a bleed (1.46, P < 0.001). CONCLUSION CD is a complex inflammatory process that is influenced by both genetic and environmental factors. Complications of CD such as fistulization, abscesses, and GI bleed are commonly seen. Our study found that women are at lower risk of developing these complications compared to men. Despite CD being primarily seen in White patients, our study found that Black and Hispanic patients are more likely to develop complications of CD. Further studies are needed to elucidate the socioeconomic and genetic factors that are responsible for these findings. Inclusion process for the study.