Race, Ethnicity Affect Epidemiology and Management of Inflammatory Bowel Diseases

By Will Boggs, MD

November 04, 2020

NEW YORK (Reuters Health) - The epidemiology and management of inflammatory bowel diseases (IBD) in the United States differ by race and ethnicity, according to a new review.

"We recognize that disparities exist among patients of different races and ethnicities with IBD," Dr. Edward L. Barnes of the University of North Carolina at Chapel Hill told Reuters Health by email. "To promote health equity among patients with IBD of different races and ethnicities, it will be critical to address the multiple underlying factors that drive these differences in care and outcomes."

Disease location and phenotype differ by ethnicity, Dr. Barnes and colleagues note in Gastroenterology. Crohn's disease (CD), for example, has a more extensive distribution of intestinal inflammation among African American, Hispanic and Asian patients than among white patients, whereas extensive ulcerative colitis (UC) is less common among Asian patients than among white patients.

Different IBD risk alleles have also been associated with different races and ethnicities. Certain known disease-associated variants are less common in Asian patients with CD than in European patients with CD, and specific risk variants have been associated with CD in African-American individuals.

Medical therapy also differs by ethnicity, according to several studies. African-American, Asian and Hispanic patients are less likely to receive biologic agents for CD, the authors say, and African Americans and Hispanics are less likely to receive immunomodulators for UC.

African-American patients with IBD appear to be less likely to be under the regular care of a gastroenterologist and more likely to be evaluated in the emergency department (ED), but no differences in ED visits have been found between Asian or Hispanic patients compared with white patients.

Racial and ethnic differences in treatment and outcomes could result from disparities in access to care, differences in insurance coverage, delays in diagnosis, treatment adherence and differences in disease perception and self-management, according to the authors.

"To better understand the drivers of disparities, we must explore factors that are responsible for differences in IBD-related outcomes at multiple levels," Dr. Barnes said. "These include the potential differences in biology (different IBD risk alleles and phenotypic presentations), but also several large issues, such as environmental influences, access to care, and social determinants of health."

"To promote health equity among patients with Crohn's disease and ulcerative colitis of different races and ethnicities, we should focus on a multistep approach to disparities," he said. "We should identify areas where disparities exist, work to better understand why these disparities exist through dedicated studies of vulnerable and/or minority populations, and then act on our findings in an effort to reduce disparities."

"At this point, I do not believe that our clinical guidelines for the management of IBD should change simply based on a patient's race or ethnicity," Dr. Barnes said. "In the larger sense, however, I think a dedication and commitment to studying disparities and the drivers of these disparities are potentially a greater way to improve outcomes in IBD, as opposed to specific guideline changes."

SOURCE: https://bit.ly/34ET5Vq Gastroenterology, online October 21, 2020.

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