S933 Racial Disparities in Extraintestinal Manifestations in Patients With Inflammatory Bowel Disease

Abstract

Introduction: Extraintestinal manifestations (EIM) are seen in 6% to 25% of IBD patients. While some EIMs occur as a direct result of bowel inflammation, other EIMs are due to an influx of mononuclear cells activated in the intestine but targeting extraintestinal organs. However, it is unclear if the pathogenesis and prevalence of EIM vary based on the race of IBD patients. Our study explored the prevalence of EIM of IBD among the major racial groups in the United States. Methods: We used a commercial database (Explorys Inc, Cleveland, OH) which includes electronic health record data from 26 major integrated US healthcare systems. Based on Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), we identified all patients (age >18 years) with a diagnosis of IBD between 1999 to 2022. Based on race, the study population was divided into two groups African American and Caucasian. The two groups were further categorized based on the extraintestinal manifestations of IBD. Results: Of the 70,383,890 individuals in the database, we identified 412,950 (0.59%) patients with IBD. Among all IBD patients, 32,870 were African American (8%) and 314,660 (76.2%) were Caucasian. When compared with Caucasians, African American IBD patients were at increased risk of pyoderma gangrenosum (OR 1.61), erythema nodosum (OR 1.39), pulmonary embolism (PE) (OR 1.06), deep vein thrombosis (DVT) (OR 1.24), interstitial lung disease (ILD) (OR 1.14), chronic kidney disease (CKD) (OR1.43), uveitis (OR 2.65), episcleritis (OR 1.78) and autoimmune hepatitis (AIH) (OR 1.54) . However, psoriasis (OR 0.49), vasculitis (OR 0.87) , ankylosing spondylitis (OR 0.82) and osteoporosis (OR 0.63) were less common in African American IBD patients (Table). Conclusion: Our large cohort of IBD patients demonstrates significant racial differences in the prevalence of EIM of IBD in the United States. The association between race and extraintestinal inflammation in IBD patients is unclear. Further research into racial variations in the pathophysiology of EIM in IBD patients is required. Table 1. - Comparison of The Prevalence of Extra-Intestinal Manifestations Among Caucasian and African-American IBD Patients AA IBD n=32,870 (%) Caucasian IBD n=314,660 (%) OR CI P-value Pyoderma Gangrenosum 210 (0.6%) 1,250 (0.4%) 1.61 1.61-1.87 < 0.0001 Erythema nodosum 180 (0.5%) 1,240 (0.4%) 1.39 1.19-1.63 < 0.0001 AIH 140 (0.4%) 870 (0.3%) 1.54 1.29-1.84 < 0.0001 ILD 1,080 (3.3%) 9,070 (2.9%) 1.14 1.07-1.22 < 0.0001 Episcleritis 80 (0.2%) 430 (0.1%) 1.78 1.40-2.26 < 0.0001 Uveitis 740 (2.3%) 2,710 (0.9%) 2.65 2.44-2.88 < 0.0001 PE 1,650 (5%) 14,930 (4.7%) 1.06 1.01-1.11 =0.0261 DVT 1,860 (5.7%) 14,500 (4.6%) 1.24 1.18-1.31 < 0.0001 CKD 4,740 (14.4%) 33,250 (10.6%) 1.43 1.38-1.47 < 0.0001 Psoriasis 440 (1.3%) 8,540 (2.7%) 0.49 0.44-0.54 < 0.0001 Vasculitis 1,930 (5.9%) 21,130 (6.7%) 0.87 0.83-0.91 < 0.0001 Ankylosing Spondylitis 250 (0.8%) 2,910 (0.9%) 0.82 0.72-0.93 = 0.0029 Osteoporosis 2,590 (7.9%) 37,680 (12%) 0.63 0.60-0.66 < 0.0001 Univariate analysis used to calculate OR, OR; odds ratio, CI; confidence interval, AA; African-American, IBD; inflammatory bowel disease, AIH;Autoimmune hepatitis, ILD; interstitial lung disease, PE; pulmonary embolism, DVT; deep venous thrombosis, CKD; chronic kidney disease.