Medical Professional Publications

Race Differences in Crohn’s Disease

Columbus, OH — July 2017

In the field of inflammatory bowel disease (IBD), racial, ethnic and socioeconomic disparities have been reported in rates of surgery, hospitalization and medical management in adults, and those same disparities have been suggested in pediatric IBD.

A recent retrospective cohort study from physician-researchers at Nationwide Children’s Hospital focused on potential racial disparity in presentation, treatment, and one-year outcomes in pediatric Crohn’s Disease, and shows that black children with Crohn’s may have more severe disease than their white peers.

“According to the Physician Global Assessment, black children had more active disease at diagnosis as well as at the one-year mark, and a lower likelihood of being in remission at either point,” says Jennifer L. Dotson, MD, MPH, a principal investigator in the Center for Innovation in Pediatric Practice at Nationwide Children’s and lead author of the study. “However, we did not identify any difference in medical treatment based on race differences.”

Dr. Dotson and her team utilized the ImproveCareNow registry, which was founded by several collaborating sites including Nationwide Children’s Hospital. The registry contains detailed treatment and demographic data for pediatric Crohn’s disease patients across the United States.

The team analyzed the information of all Crohn’s patients 21 years of age or younger who received treatment over a period of eight years. They found that black children were also less likely to have at least one visit in remission within the first year, or have satisfactory growth at the one-year mark. The team determined that black children had lower hematocrit and albumin levels at diagnosis as well as at the one-year follow up. However, there were no differences in disease phenotype by race at the one-year follow up point.

“Taken collectively, our data suggests that black patients may have an increase in disease activity during the first year of diagnosis, despite similar treatment and number of follow up visits to their peers,” adds Dr. Dotson, also a physician in the Division of Gastroenterology, Hepatology and Nutrition at Nationwide Children’s and a member of the Division’s Inflammatory Bowel Disease Center. “The reasons for this are unclear, but may suggest that Crohn’s disease is more severe in black children and/or that they may respond less well or quickly to existing medication options.”

The research team emphasizes the gaps in literature on health care disparities in pediatric Crohn’s disease patients and hopes that by adding to the current body of knowledge, the sources of such disparities can be identified and potentially mitigated for better outcomes.

“The significance of these disparities and the reasons for them require further investigation, like multicenter prospective studies. We need to clarify the role of socioeconomic, genetic, psychosocial, and other factors that could contribute to what we’re seeing,” Dr. Dotson says.

 

Reference:
Dotson JL et al. Race Differences in Initial Presentation, Early Treatment, and 1-year Outcomes of Pediatric Crohn’s Disease: Results from the ImproveCareNow Network.Inflammatory Bowel Diseases. 20 Feb 2017. [Epub ahead of print]

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