As of the data accession October 1, 2003, 1,406 cohort patients—138 (10%) AA and 1,268 (90%) non-AA (83% Caucasian; 3% Hispanic; 2% Asian/Pacific Islander; and 2% Non-AA, race not specified)—had complete data for IBD classification, age at diagnosis, self- or parent-reported age of IBD symptom onset and self- or parent-reported race/ethnicity. Of these, 51% (N=719), 44% (N=624) and 38% (N=529) had recorded Hgb, ESR and Alb, respectively, at the time of diagnosis. Z-scores for height and weight were available for 59% (N=835) and 63% (N=886) of patients, respectively. . Forty-two percent (N=593) of the cohort had received some type of immunomodulatory therapy by 30 days after diagnosis and the entire cohort had data on the presence or absence of EIMC at the time of diagnosis. Due to the manner of data extraction from the registry, absolute numbers and mean values for Hgb, ESR and Alb were not available for analyses.
Overall, 860 (61%) of the study cohort children were diagnosed with CD, 409 (29%) with UC and 137 (10%) with IC. Of these, 107 AA and 753 non-AA had CD. Proportionally more AA (78% of the cohort AA), compared to non-AA (59% of the cohort non-AA), had CD (OR 2.36, 95% CI 1.56–3.58). Conversely, proportionally fewer AA (18%; N=25) versus non-AA (30%; N=384) had UC (OR 0.51, 95% CI 0.32–0.80). Only, 6 AA (4% of the cohort AA) and 131 non-AA (10% of the cohort non-AA) had IC (OR 0.39, 95% CI 0.17–0.91) (). The proportions of male African-Americans (N=69, 50%) and non-African-Americans (N=686, 54%) with IBD were similar ().
Figure 1 Disease classification of the pediatric IBD patient cohort we analyzed comparing those African American patients to non-African American. Statistically significant differences were observed between African American children with Crohn's compared to non-African (more ...)
Gender classification of our pediatric IBD cohort comparing males to females whether African American or non-African American. There were no statistically significant differences in the gender distribution in either main racial/ethnic categories.
The distributions of age at IBD diagnosis and age at symptom onset, by race/ethnicity, are depicted for each disease classification in and , respectively. Of the entire cohort, 547 (39%) and 448 (32%) children were >12 years old at the time of diagnosis and at symptom onset, respectively. A significantly greater proportion of AA, compared to non-AA, were >12 years old when diagnosed with any IBD (52% vs. 37%, OR 1.82, 95% CI 1.28–2.59) as well as with UC (56% vs. 33%, OR 2.58, 95% CI 1.14–5.83) (). A greater proportion of AA with any type of IBD also had symptom onset after 12 years of age compared to non-AA patients (46% vs. 30%, OR 1.99, CI 1.40–2.84). Significant racial-ethnic differences were observed in age at symptom onset >12 years for CD (45% AA vs. 32% non-AA; OR 1.74, CI 1.15–2.62) and UC (56% AA vs. 29% non-AA; OR 3.05, CI 1.34–6.93 ().
Distribution of Age at Disease Diagnosis, by Racial/Ethnic Group (African-American, non-African-American)
Distribution of Age at Disease Symptom Onset, by Racial/Ethnic group (African-American, non-African-American)
Figure 3 The proportion of African American children versus non-African American children diagnosed after the age of 12 years by disease category (all IBD, CD, UC or IC). Interestingly, for reasons yet to be explained, statistically more African American children (more ...)
Figure 4 The proportion of African American children versus non-African American children with symptom onset after the age of 12 years by disease category (all IBD, CD, UC or IC). In our cohort, statistically more African American children had symptom onset whether (more ...)
Irrespective of race, 254 children (18% of the entire study cohort) had symptom onset and 216 (15% of the entire study cohort) were diagnosed with IBD before 6 years of age ( and ). Of these, a significantly smaller proportion of AA (7%, N=10) when compared with non-AA (16%, N=206) were diagnosed at <6 years old (OR 0.40 95% CI 0.21–0.78) (). Of the 1,406 cohort IBD subjects, significantly lower proportions of AA (10%; N=14) than non-AA (19%; N=240) reported symptom onset by 6 years of age (OR 0.48, 95% CI 0.27–0.86) (). Among the 1,406 cohort IBD patients, 643 (46%) were between 6 and 12 years old at IBD diagnosis () while 704 (50%) were between 6 and 12 years old at the onset of IBD symptoms (). The proportions of AA and non-AA diagnosed or with symptom onset between 6 and 12 years old did not differ statistically for all IBD, CD, UC or IC (–).
IBD – Parameters at Diagnosis
IC – Parameters at Diagnosis
Seven hundred nineteen (719) IBD cohort children had a recorded Hgb at time of diagnosis, 448 with CD, 202 with UC and 69 with IC; 79 (11%) were AA and 640 (89%) were non-AA. In the entire cohort, a significantly greater proportion of AA (39%; N=31) than non-AA (17%; N=109) had abnormally low Hgb levels (OR 3.15, 95% CI 1.92–5.17) (). Of the 61 AA and 387 non-AA with CD and recorded Hgb data, a significantly greater proportion of AA had abnormally low Hgb levels (43% vs. 19%; OR 3.20, 95% CI 1.81–5.64) (). Only 13 AA and 189 non-AA with recorded Hgb had UC, while 5 AA and 64 non-AA had IC. Although the proportions were higher for AA, they did not met statistical significance (, ).
CD – Parameters at Diagnosis
UC – Parameters at Diagnosis
Of the 624 children with ESR recorded at diagnosis (395 CD, 175 UC, 54 IC), the proportion of AA with abnormally elevated ESR was significantly greater than non-AA for combined IBD diagnoses (80% vs. 55%; OR 3.24, 95% CI 1.76–5.97), and separately for CD (78% vs. 64%; OR 2.05, 95% CI 1.02 – 4.14) and UC (92% vs. 43%; OR 15.77, 95% CI 2.00–124.2) (, and ). For the 529 children with a recorded Alb at diagnosis (328 CD, 156 UC, 45 IC), no racial differences existed in the proportions with abnormally low levels, for any IBD disease classification (–).
The database recorded whether or not the child received corticosteroids, 6-mercaptopurine, azathioprine or Infliximab, alone or in any combination, around the time of diagnosis for all of the 1,406 cohort children. Early treatment with immunomodulatory agents (within 30 days of diagnosis) was given to 593 patients, including a significantly greater proportion of AA: 57% (N=78) compared to 41% (N=515) of non-AA (OR 1.90, 95% CI 1.33–2.71) (). This racial/ethnic difference in early therapy was also noted among those with CD: 56% (N=60) of AA compared to 45% (N= 342) of non-AA (OR 1.53, 95% CI 1.02–2.31) and those with UC: 60% (N=15) of AA compared to 35% (N=133) of non-AA (OR 2.83, 95% CI 1.24–6.47) ( and ). Analyses found no statistically significant difference in race/ethnicity among the IC patients receiving early immunomodulatory therapy (). No significant difference existed in the proportions of AA and non-AA with IBD or any IBD subtype who received corticosteroid monotherapy (–).
The entire cohort had information recorded for the presence or absence of EIMC. The frequencies of EIMC did not differ with regard to race/ethnicity (, , , and ). Subanalyses of each EIMC were not performed.
Examining data on all CD discerned no racial/ethnic differences in the proportions of patients with perianal disease, strictures or fistulae (). The proportions of AA and non-AA with abnormally low z-scores for height and weight were similar for the 835 and 886 patients, respectively, with recorded data. Distributions of anatomic disease location were similar among AA and non-AA for both CD and UC (–).
CD Disease Location and Complications at Diagnosis