The Search for Phenotypic Differences in IBD Between AfroCaribbeans and AfroAmericans

Abstract

Purpose: Phenotypic differences in Inflammatory Bowel Disease (IBD) exist among racial groups (Caucasians, Hispanics, African Americans) as published in 2006 by Nguyen et al. Citizens of West Indian and Haitian ancestry make up 7% of all blacks in the U.S. In our urban medical center, the predominant ethnic background amongst patients is that of AfroCaribbean. In this study, we compare the differences in IBD between the understudied Afro-Caribbeans (AC) population and their African Americans (AA) counterparts as described in 2006 by Nguyen et al. Methods: In an IRB-approved retrospective study, AfroCaribbean patients with IBD who were treated in our institution's hospital and clinics were identified via ICD-9 codes. Data were compiled on gender, age, disease type, family history of IBD, and extra-intestinal manifestations. As African Americans are rarely seen in our institution, our results were compared to African American data described in Nguyen et al's 2006 North American Cohort Study of IBD patients. Results: 122 AC IBD patients (43% women) were compared against 127 AA patients (37% women). Mean age of AC patients was 47.8 (36.1 for AA) with age of diagnosis being 36.9 (25 for AA). See Table 1 for differences. Significantly less Crohn's was observed in AfroCaribbeans as well as less known family history of IBD. Otherwise, no statistical differences were observed between the two groups.Table: IBD Phenotype in AfroCaribbeans compared to American Americans in the North American Cohort StudyConclusion: Comparing our AfroCaribbean data to that of Nguyen's African American Cohort, there appears to be little difference in the expression of IBD. An obvious limitation is that we did not have our own data on AA patients. Furthermore, with such a small percentage of AC patients with Crohn's, lack of statistical differences may indeed stem from Type II error. With their own distinct culture, AfroCaribbeans have had reported differences including higher level of education, higher stress levels, lower incidence of breast cancer, and more chronic hypertension when compared to American Americans. While expression of IBD did not distinguish AC patients from what has been reported among AA patients, it is still important to appreciate cultural distinctions within the patient populations we treat particularly as dietary influences may contribute to disease course. Furthermore, with the dawn of IBD genetic markers differentiating patients by disease course and prognosis, it would be interesting to see if such differences could be observed between AC and AA patients as well as in other racial/ethnic groups. Further studies will elucidate this subject. Disclosure: Dr Frank Gress: Novartis, Speakers Bureau. Dr Charles Koczka - none. Dr. Ismet Lukolic - none. Dr. Cynthia Victor - none. Dr David Lee - none. Dr. Ying Taur - none.