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Sanat ZM, Vahedi H, Malekzadeh R, Fanni Z. Epidemiologic profile of inflammatory bowel disease in Eastern Mediterranean Region (EMRO) countries: a systematic review and meta-analysis. BMC Public Health 2024; 24:1395. [PMID: 38789987 PMCID: PMC11127456 DOI: 10.1186/s12889-024-18816-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) consists of two main types: Crohn's disease (CD) and ulcerative colitis (UC). The epidemiology of IBD patients has not been comprehensively studied in EMRO countries; therefore, we conducted this meta-analysis to study the epidemiology of this disease in these countries. METHODS We searched four international databases, namely Scopus, Web of Knowledge (ISI), Medline/PubMed, and ProQuest, from inception up to the end of May 2023. The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guideline was used to carry out this systematic review and meta-analysis investigation. Using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist, the quality of the selected papers was assessed. RESULTS Based on the results of this study, the incidence of UC in EMRO countries was 2.65 per 100,000 (95% CI: 1.39-3.90), and the incidence of CD was 1.16 per 100,000 (95% CI: 0.73-1.59). The most commonly involved intestinal segment in CD was the terminal ileum (44.7%, 95% CI: 34.7-55.2), followed by the ileum (29.8%, 95% CI: 22.2-38.6), and colon (18.7%, 95% CI: 10.8-30.4). However, in UC patients, extensive colitis was the most common finding (32.3%, 95% CI: 26.4-38.8), followed by proctosigmoiditis (27.9%, 95% CI: 21.1-35.8), left-sided colitis (27.4%, 95% CI: 22.7-32.7), and proctitis (22.6%, 95% CI: 17.5-28.5). CONCLUSION As a result, we were able to establish the traits of IBD patients in EMRO nations. UC patients had a higher incidence than CD patients. The most common regions of involvement in CD and UC patients, respectively, were the colon and pancolitis. Compared to UC patients, CD patients had a higher history of appendectomy.
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Affiliation(s)
- Zahra Momayez Sanat
- Assistant Professor of Gastroenterology and Hepatology, Tehran University of Medical Sciences, Tehran, Iran
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Homayoon Vahedi
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Malekzadeh
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Fanni
- Assistant Professor of Gastroenterology and Hepatology, Tehran University of Medical Sciences, Tehran, Iran.
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Tandon P, Chhibba T, Natt N, Singh Brar G, Malhi G, Nguyen GC. Significant Racial and Ethnic Disparities Exist in Health Care Utilization in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Inflamm Bowel Dis 2024; 30:470-481. [PMID: 36975373 DOI: 10.1093/ibd/izad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Indexed: 03/29/2023]
Abstract
BACKGROUND The incidence of inflammatory bowel disease (IBD) is rising worldwide, though the differences in health care utilization among different races and ethnicities remains uncertain. We aimed to better define this through a systematic review and meta-analysis. METHODS We explored the impact of race or ethnicity on the likelihood of needing an IBD-related surgery, hospitalization, and emergency department visit. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with I2 values reporting heterogeneity. Differences in IBD phenotype and treatment between racial and ethnic groups of IBD were reported. RESULTS Fifty-eight studies were included. Compared with White patients, Black patients were less likely to undergo a Crohn's disease (CD; OR, 0.69; 95% CI, 0.50-0.95; I2 = 68.0%) or ulcerative colitis (OR, 0.58; 95% CI, 0.40-0.83; I2 = 85.0%) surgery, more likely to have an IBD-hospitalization (OR, 1.54; 95% CI, 1.06-2.24; I2 = 77.0%), and more likely to visit the emergency department (OR, 1.74; 95% CI, 1.32-2.30; I2 = 0%). There were no significant differences in disease behavior or biologic exposure between Black and White patients. Hispanic patients were less likely to undergo a CD surgery (OR, 0.57; 95% CI, 0.48-0.68; I2 = 0%) but more likely to be hospitalized (OR, 1.38; 95% CI, 1.01-1.88; I2 = 37.0%) compared with White patients. There were no differences in health care utilization between White and Asian or South Asian patients with IBD. CONCLUSIONS There remain significant differences in health care utilization among races and ethnicities in IBD. Future research is required to determine factors behind these differences to achieve equitable care for persons living with IBD.
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Affiliation(s)
- Parul Tandon
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Tarun Chhibba
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Navneet Natt
- Department of Medicine, Northern Ontario School of Medicine, Ontario, Canada
| | - Gurmun Singh Brar
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gurpreet Malhi
- Department of Medicine, Western University, London, Ontario, Canada
| | - Geoffrey C Nguyen
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Khalessi A, Crowe BR, Xia Y, Rubinfeld G, Baylor J, Radin A, Liang PS, Chen LA. Differential Manifestations of Inflammatory Bowel Disease Based on Race and Immigration Status. GASTRO HEP ADVANCES 2023; 3:326-332. [PMID: 38765199 PMCID: PMC11101196 DOI: 10.1016/j.gastha.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
BACKGROUND AND AIMS The prevalence of inflammatory bowel disease (IBD) is increasing globally. In this context, identifying risk factors for severe disease is important. We examined how race/ethnicity and immigration status influence IBD manifestations, treatments, and outcomes in a diverse, tertiary-care safety-net hospital. METHODS We conducted a single-center retrospective review of all IBD inpatients and outpatients treated from 1997-2017. Using logistic regression modeling, we compared disease onset, treatment, and outcomes by race (White, Black, Hispanic, or Asian) and immigration status (US-born vs foreign-born). RESULTS A total of 577 patients were identified, of which 29.8% were White, 27.4% were Hispanic, 21.7% were Black, and 13.0% were Asian. Compared to Whites, Asians were more likely to be male (odds ratio [OR] 2.63, 95% confidence interval [CI]: 1.45, 5.00), whereas Blacks were more likely to be diagnosed with Crohn's disease (OR 1.75, 95% CI: 1.10, 2.77) and more likely to undergo IBD-related intestinal resection (OR 2.49, 95% CI: 1.40, 4.50). Compared to US-born patients, foreign-born patients were more likely to be diagnosed with ulcerative colitis (OR 1.77, 95% CI: 1.04, 3.02). They were also less likely to be diagnosed before 16 years of age (OR 0.19, 95% CI: 0.08, 0.41), to have undergone intestinal resections (OR 0.39, 95% CI: 0.19, 0.83), to have received biologics (OR 0.43, 95% CI: 0.25, 0.76), or to have had dermatologic manifestations (OR 0.12, 95% CI: 0.03, 0.41). CONCLUSION IBD phenotype varies by race, although foreign-born patients of all races show evidence of later-onset and milder disease. These findings may aid in disease prognostication and clinical management and, furthermore, may provide insight into intrinsic and environmental influences on IBD pathogenesis.
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Affiliation(s)
- Ali Khalessi
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Brooks R. Crowe
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Yuhe Xia
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York
| | - Gregory Rubinfeld
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Jessica Baylor
- Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Arielle Radin
- Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, New York
| | - Peter S. Liang
- Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, New York
- VA New York Harbor Health Care System, New York, New York
| | - Lea Ann Chen
- Division of Gastroenterology, Department of Medicine, New York University School of Medicine, New York, New York
- NYC Health + Hospitals/Bellevue, New York, New York
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Burisch J, Zhao M, Odes S, De Cruz P, Vermeire S, Bernstein CN, Kaplan GG, Duricova D, Greenberg D, Melberg HO, Watanabe M, Ahn HS, Targownik L, Pittet VEH, Annese V, Park KT, Katsanos KH, Høivik ML, Krznaric Z, Chaparro M, Loftus EV, Lakatos PL, Gisbert JP, Bemelman W, Moum B, Gearry RB, Kappelman MD, Hart A, Pierik MJ, Andrews JM, Ng SC, D'Inca R, Munkholm P. The cost of inflammatory bowel disease in high-income settings: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol Hepatol 2023; 8:458-492. [PMID: 36871566 DOI: 10.1016/s2468-1253(23)00003-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 03/06/2023]
Abstract
The cost of caring for patients with inflammatory bowel disease (IBD) continues to increase worldwide. The cause is not only a steady increase in the prevalence of Crohn's disease and ulcerative colitis in both developed and newly industrialised countries, but also the chronic nature of the diseases, the need for long-term, often expensive treatments, the use of more intensive disease monitoring strategies, and the effect of the diseases on economic productivity. This Commission draws together a wide range of expertise to discuss the current costs of IBD care, the drivers of increasing costs, and how to deliver affordable care for IBD in the future. The key conclusions are that (1) increases in health-care costs must be evaluated against improved disease management and reductions in indirect costs, and (2) that overarching systems for data interoperability, registries, and big data approaches must be established for continuous assessment of effectiveness, costs, and the cost-effectiveness of care. International collaborations should be sought out to evaluate novel models of care (eg, value-based health care, including integrated health care, and participatory health-care models), as well as to improve the education and training of clinicians, patients, and policy makers.
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Affiliation(s)
- Johan Burisch
- Gastro Unit, Medical Division, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark; Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark.
| | - Mirabella Zhao
- Gastro Unit, Medical Division, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark; Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Selwyn Odes
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Peter De Cruz
- Department of Gastroenterology, Austin Health, Melbourne, VIC, Australia; Department of Medicine, Austin Academic Centre, The University of Melbourne, Melbourne, VIC, Australia
| | - Severine Vermeire
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium; Faculty of Medicine, KU Leuven University, Leuven, Belgium
| | - Charles N Bernstein
- IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada; Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Gilaad G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Dana Duricova
- IBD Clinical and Research Centre for IBD, ISCARE, Prague, Czech Republic; Department of Pharmacology, Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hans O Melberg
- Department of Community Medicine, University of Tromsø-The Arctic University of Norway, Tromsø, Norway; Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Mamoru Watanabe
- Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Laura Targownik
- Division of Gastroenterology and Hepatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Valérie E H Pittet
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Vito Annese
- Division of Gastroenterology, Department of Internal Medicine, Fakeeh University Hospital, Dubai, United Arab Emirates
| | - K T Park
- Stanford Health Care, Packard Health Alliance, Alameda, CA, USA; Genentech (Roche Group), South San Francisco, CA, USA
| | - Konstantinos H Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Ioannina School of Health Sciences, Ioannina, Greece
| | - Marte L Høivik
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Zagreb, Zagreb, Croatia
| | - María Chaparro
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Montreal, QC, Canada; Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Willem Bemelman
- Department of Surgery, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Bjorn Moum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Richard B Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Michael D Kappelman
- Division of Pediatric Gastroenterology, Department of Pediatrics and Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ailsa Hart
- IBD Unit, St Mark's Hospital, Middlesex, UK
| | - Marieke J Pierik
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jane M Andrews
- IBD Service, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia; Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Siew C Ng
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Renata D'Inca
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Pia Munkholm
- Department of Gastroenterology, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
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Diversity, equity, and inclusion in gastroenterology and hepatology: a survey of where we stand. Gastrointest Endosc 2022; 96:887-897. [PMID: 36241459 DOI: 10.1016/j.gie.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 06/15/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS In the setting of increasing attention to representation in medicine, we aimed to assess current perspectives of racial and ethnic workforce diversity and health care disparities among gastroenterology (GI) and hepatology professionals in the United States. METHODS We developed and administered a 33-item electronic cross-sectional survey to members of 5 national GI and hepatology societies. Survey items were organized into thematic modules and solicited perspectives on racial and ethnic workforce diversity, health care disparities in GI and hepatology, and potential interventions to enhance workforce diversity and improve health equity. RESULTS Of the 1219 survey participants, 62.3% were male, 48.7% were non-Hispanic White, and 19.9% were from backgrounds underrepresented in medicine. The most frequently reported barriers to increasing racial and ethnic diversity in GI and hepatology were insufficient representation of underrepresented racial and ethnic minority groups in the education and training pipeline (n = 431 [35.4%]), in professional leadership (n = 340 [27.9%]), and among practicing GI and hepatology professionals (n = 324 [26.6%]). Suggested interventions were to increase career mentorship opportunities (n = 545 [44.7%]), medical student opportunities (n = 520 [42.7%]), and program and professional society leadership roles for underrepresented racial and ethnic minority groups (n = 473 [38.8%]). CONCLUSIONS Our survey explored imperative and timely perspectives on racial and ethnic representation and health equity among professionals in GI and hepatology. The findings should inform future interventions to address workforce diversity and establish priorities toward improving health equity, ultimately serving as a springboard for professional societies, academic institutions, and other organizations that aim to increase diversity, equity, and inclusion in our field.
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Xu F, Liu Y, Greenlund K, Carlson S. Trends and demographic patterns in biologic and corticosteroid prescriptions for inflammatory bowel disease: findings from electronic medical records, 2011-2020. J Investig Med 2022; 70:1771-1776. [PMID: 36455956 PMCID: PMC10468819 DOI: 10.1136/jim-2022-002486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/03/2022]
Abstract
Prescriptions for biologic therapy for treatment of Crohn's disease (CD) and ulcerative colitis (UC) have increased during the past two decades; however, trends are less clear regarding corticosteroid prescriptions in this context. We designed a cross-sectional study using the IQVIA Ambulatory Electronic Medical Records databases. Weighted linear regressions by age group were used to estimate annual percentage change from 2011 to 2020 in prescriptions for biologics and for corticosteroids among patients with or without biologic prescriptions within the same calendar year. Using 2019 data, we compared patient demographic and lifestyle risk factors using χ2 test for biologic prescriptions and corticosteroids with or without biologics prescriptions. There was an 11% (CD) and 16% (UC) annual increase in the percentage of patients prescribed biologics during the study period. The percentage of patients with biologics prescriptions prescribed corticosteroids decreased by 2% (CD) and 3% (UC) annually after 2015, while the percentage remained unchanged for corticosteroid prescriptions among patients without biologics. In 2019, differences in medication prescriptions existed by patient's demographic and lifestyle factors for patients with CD (n=52,892) and UC (n=52,280), including a higher percentage prescribed biologics among younger patients, men, those with fewer comorbidities, and current alcohol drinkers, and a higher percentage prescribed corticosteroids without biologics among women, those with more comorbidities, and a history of smoking. While medications continue to evolve during the biologic era, it is important to continue to monitor trends and differences in prescription patterns to assess progress toward optimizing treatment for patients with CD or UC.
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Affiliation(s)
- Fang Xu
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yong Liu
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kurt Greenlund
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan Carlson
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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7
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Ore AS, Vigna C, Fabrizio A, Messaris E. Evaluation of Racial/Ethnic Disparities in the Surgical Management of Inflammatory Bowel Disease. J Gastrointest Surg 2022; 26:2559-2568. [PMID: 36253503 DOI: 10.1007/s11605-022-05483-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/25/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Disparities in managing inflammatory bowel disease (IBD) are multifactorial and occur at all stages of treatment, including surgical management. We aim to evaluate postoperative morbidity after abdominopelvic surgery among different racial/ethnic groups after surgical management of CD and UC and account for preoperative characteristics that may impact outcomes. METHODS Patients were identified using the National Surgical Quality Improvement Project (NSQIP) file and merged with the targeted proctectomy (2016-2019) and colectomy file (2012-2019). All patients undergoing elective surgical management for ICD9/10 codes for CD and UC were included. The primary outcome was composite postoperative morbidity (CPM), a metric that identifies postoperative morbidity with available variables. Multivariable logistic regression modeling was performed to test the association between race/ethnicity and other risk factors with CPM. Postoperative outcomes were evaluated using propensity score modeling with 1:1 matching without replacement as a secondary analysis. RESULTS In both CD and UC, CPM was highest for Black patients with 27.5% (326) and 26.1% (81), respectively. Followed by Hispanic patients with a CPM of 21.1% (73) after surgery for CD (p < 0.001) and 21.2% (31) for Asian patients after resection for UC (p = 0.005). After regression modeling, we found increased odds of CPM for Black patients after surgery for UC (OR 1.48, p = 0.013) and CD (OR 1.17, p < 0.001). Following propensity score matching (PSM), stoma creation rates were higher in Asian (10.4%, p = 0.010) and Hispanic patients (11.9%, p = 0.030) undergoing surgery for CD. CONCLUSIONS Black patients are at increased risk of morbidity after surgery for both UC and CD. Increased morbidity in an already vulnerable population warrants targeted interventions, specifically focusing on faster access to specialized care, preoperative optimization, and culturally competent discussions on the benefits of MIS approaches are warranted in order to improve postoperative outcomes.
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Affiliation(s)
- Ana Sofia Ore
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, USA
| | - Carolina Vigna
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, USA
| | - Anne Fabrizio
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, USA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, USA.
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Rahal HK, Tabibian JH, Issaka RB, Quezada S, Gray DM, Balzora S, Yang L, Badiee J, May FP. Diversity, equity, and inclusion in gastroenterology and hepatology: A survey of where we stand. Hepatology 2022; 76:1825-1835. [PMID: 36219467 DOI: 10.1002/hep.32757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS In the setting of increasing attention to representation in medicine, we aimed to assess current perspectives of racial and ethnic workforce diversity and health care disparities among gastroenterology (GI) and hepatology professionals in the United States. APPROACH AND RESULTS We developed and administered a 33-item electronic cross-sectional survey to members of five national GI and hepatology societies. Survey items were organized into thematic modules and solicited perspectives on racial and ethnic workforce diversity, health care disparities in GI and hepatology, and potential interventions to enhance workforce diversity and improve health equity. Of the 1219 survey participants, 62.3% were male, 48.7% were non-Hispanic White, and 19.9% were from backgrounds underrepresented in medicine. The most frequently reported barriers to increasing racial and ethnic diversity in GI and hepatology were insufficient representation of underrepresented racial and ethnic minority groups in the education and training pipeline (n = 431 [35.4%]), in professional leadership (n = 340 [27.9%]), and among practicing GI and hepatology professionals (n = 324 [26.6%]). Suggested interventions were to increase career mentorship opportunities (n = 545 [44.7%]), medical student opportunities (n = 520 [42.7%]), and program and professional society leadership roles for underrepresented racial and ethnic minority groups (n = 473 [38.8%]). CONCLUSIONS Our survey explored imperative and timely perspectives on racial and ethnic representation and health equity among professionals in GI and hepatology. The findings should inform future interventions to address workforce diversity and establish priorities toward improving health equity, ultimately serving as a springboard for professional societies, academic institutions, and other organizations that aim to increase diversity, equity, and inclusion in our field.
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Affiliation(s)
- Harman K Rahal
- Department of Medicine, David Geffen School of MedicineUniversity of California-Los AngelesLos AngelesCaliforniaUSA.,Karsh Division of Gastroenterology and HepatologyCedars-Sinai Medical CenterLos AngelesCaliforniaUSA.,Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of MedicineUniversity of California-Los AngelesLos AngelesCaliforniaUSA
| | - James H Tabibian
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of MedicineUniversity of California-Los AngelesLos AngelesCaliforniaUSA.,Division of Gastroenterology, Department of MedicineOlive View-UCLA Medical CenterSylmarCaliforniaUSA
| | - Rachel B Issaka
- Clinical Research and Public Health Sciences DivisionsFred Hutchinson Cancer Research CenterSeattleWashingtonUSA.,Division of Gastroenterology, Department of MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Sandra Quezada
- Department of Medicine, Division of Gastroenterology and HepatologyUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Darrell M Gray
- Division of Gastroenterology, Hepatology and Nutrition, College of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Sophie Balzora
- Division of Gastroenterology and HepatologyNYU Langone HealthNew YorkNew YorkUSA
| | - Liu Yang
- Department of Medicine, David Geffen School of MedicineUniversity of California-Los AngelesLos AngelesCaliforniaUSA.,Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of MedicineUniversity of California-Los AngelesLos AngelesCaliforniaUSA
| | - Jayraan Badiee
- Department of Medicine, David Geffen School of MedicineUniversity of California-Los AngelesLos AngelesCaliforniaUSA.,Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of MedicineUniversity of California-Los AngelesLos AngelesCaliforniaUSA
| | - Folasade P May
- Department of Medicine, David Geffen School of MedicineUniversity of California-Los AngelesLos AngelesCaliforniaUSA.,Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of MedicineUniversity of California-Los AngelesLos AngelesCaliforniaUSA.,UCLA Kaiser Permanente Center for Health EquityJonsson Comprehensive Cancer Center, University of California-Los AngelesLos AngelesCaliforniaUSA.,Division of Gastroenterology, Department of MedicineVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
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9
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Rahal HK, Tabibian JH, Issaka RB, Quezada S, Gray DM, Balzora S, Yang L, Badiee J, May FP. Diversity, Equity, and Inclusion in Gastroenterology and Hepatology: A Survey of Where We Stand. Gastroenterology 2022; 163:1702-1711. [PMID: 36241487 DOI: 10.1053/j.gastro.2022.06.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 05/25/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS In the setting of increasing attention to representation in medicine, we aimed to assess current perspectives of racial and ethnic workforce diversity and health care disparities among gastroenterology (GI) and hepatology professionals in the United States. METHODS We developed and administered a 33-item electronic cross-sectional survey to members of 5 national GI and hepatology societies. Survey items were organized into thematic modules and solicited perspectives on racial and ethnic workforce diversity, health care disparities in GI and hepatology, and potential interventions to enhance workforce diversity and improve health equity. RESULTS Of the 1219 survey participants, 62.3% were male, 48.7% were non-Hispanic White, and 19.9% were from backgrounds underrepresented in medicine. The most frequently reported barriers to increasing racial and ethnic diversity in GI and hepatology were insufficient representation of underrepresented racial and ethnic minority groups in the education and training pipeline (n = 431 [35.4%]), in professional leadership (n = 340 [27.9%]), and among practicing GI and hepatology professionals (n = 324 [26.6%]). Suggested interventions were to increase career mentorship opportunities (n = 545 [44.7%]), medical student opportunities (n = 520 [42.7%]), and program and professional society leadership roles for underrepresented racial and ethnic minority groups (n = 473 [38.8%]). CONCLUSIONS Our survey explored imperative and timely perspectives on racial and ethnic representation and health equity among professionals in GI and hepatology. The findings should inform future interventions to address workforce diversity and establish priorities toward improving health equity, ultimately serving as a springboard for professional societies, academic institutions, and other organizations that aim to increase diversity, equity, and inclusion in our field.
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Affiliation(s)
- Harman K Rahal
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| | - James H Tabibian
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California
| | - Rachel B Issaka
- Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Sandra Quezada
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Darrell M Gray
- Division of Gastroenterology, Hepatology and Nutrition, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Sophie Balzora
- Division of Gastroenterology and Hepatology, NYU Langone Health, New York, New York
| | - Liu Yang
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Jayraan Badiee
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Folasade P May
- Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; UCLA Kaiser Permanente Center for Health Equity, Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California; Division of Gastroenterology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
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10
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Diversity, Equity, and Inclusion in Gastroenterology and Hepatology: A Survey of Where We Stand. Am J Gastroenterol 2022; 117:1954-1962. [PMID: 36040427 PMCID: PMC9722387 DOI: 10.14309/ajg.0000000000001984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 06/15/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION In the setting of increasing attention to representation in medicine, we aimed to assess current perspectives of racial and ethnic workforce diversity and health care disparities among gastroenterology (GI) and hepatology professionals in the United States. METHODS We developed and administered a 33-item electronic cross-sectional survey to members of 5 national GI and hepatology societies. Survey items were organized into thematic modules and solicited perspectives on racial and ethnic workforce diversity, health care disparities in GI and hepatology, and potential interventions to enhance workforce diversity and improve health equity. RESULTS Of the 1,219 survey participants, 62.3% were male, 48.7% were non-Hispanic White, and 19.9% were from backgrounds underrepresented in medicine. The most frequently reported barriers to increasing racial and ethnic diversity in GI and hepatology were insufficient representation of underrepresented racial and ethnic minority groups in the education and training pipeline (n = 431 [35.4%]), in professional leadership (n = 340 [27.9%]), and among practicing GI and hepatology professionals (n = 324 [26.6%]). Suggested interventions were to increase career mentorship opportunities (n = 545 [44.7%]), medical student opportunities (n = 520 [42.7%]), and program and professional society leadership roles for underrepresented racial and ethnic minority groups (n = 473 [38.8%]). DISCUSSION Our survey explored imperative and timely perspectives on racial and ethnic representation and health equity among professionals in GI and hepatology. The findings should inform future interventions to address workforce diversity and establish priorities toward improving health equity, ultimately serving as a springboard for professional societies, academic institutions, and other organizations that aim to increase diversity, equity, and inclusion in our field.
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Booth A, Ford W, Brennan E, Magwood G, Forster E, Curran T. Towards Equitable Surgical Management of Inflammatory Bowel Disease: A Systematic Review of Disparities in Surgery for Inflammatory Bowel Disease. Inflamm Bowel Dis 2022; 28:1405-1419. [PMID: 34553754 DOI: 10.1093/ibd/izab237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Existing evidence for disparities in inflammatory bowel disease is fragmented and heterogenous. Underlying mechanisms for differences in outcomes based on race and socioeconomic status remain undefined. We performed a systematic review of the literature to examine disparities in surgery for inflammatory bowel disease in the United States. METHODS Electronic databases were searched from 2000 through June 11, 2021, to identify studies addressing disparities in surgical treatment for adults with inflammatory bowel disease. Eligible English-language publications comparing the use or outcomes of surgery by racial/ethnic, socioeconomic, geographic, and/or institutional factors were included. Studies were grouped according to whether outcomes of surgery were reported or surgery itself was the relevant end point (utilization). Quality was assessed using the Newcastle-Ottawa Scale for observational studies. RESULTS Forty-five studies were included. Twenty-four reported surgical outcomes and 21addressed utilization. Race/ethnicity was considered in 96% of studies, socioeconomic status in 44%, geographic factors in 27%, and hospital/surgeon factors in 22%. Although study populations and end points were heterogeneous, Black and Hispanic patients were less likely to undergo abdominal surgery when hospitalized; they were more likely to have a complication when they did have surgery. Differences based on race were correlated with socioeconomic factors but frequently remained significant after adjustments for insurance and baseline health. CONCLUSIONS Surgical disparities based on sociologic and structural factors reflect unidentified differences in multidisciplinary disease management. A broad, multidimensional approach to disparities research with more granular and diverse data sources is needed to improve health care quality and equity for inflammatory bowel disease.
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Affiliation(s)
- Alexander Booth
- Division of Colon and Rectal Surgery, Medical University of South Carolina, Charleston, SC, USA.,Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA
| | - Wilson Ford
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Emily Brennan
- Colbert Education Center and Library, Medical University of South Carolina, Charleston, SC, USA
| | - Gayenell Magwood
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Erin Forster
- Division of Gastroenterology, Hepatology and Nutrition, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas Curran
- Division of Colon and Rectal Surgery, Medical University of South Carolina, Charleston, SC, USA
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12
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Bhurwal A, Minacapelli CD, Patel A, Mutneja H, Goel A, Shah I, Bansal V, Brahmbhatt B, Das KM. Evaluation of a U.S. National Cohort to Determine Utilization in Colectomy Rates for Ulcerative Colitis Among Ethnicities. Inflamm Bowel Dis 2022; 28:54-61. [PMID: 33534892 DOI: 10.1093/ibd/izab020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Colectomy is the curative management for ulcerative colitis (UC). Multiple studies have reported racial disparities for colectomy before the advent of anti-TNF alpha agents. The aim of this study was to describe racial and geographic differences in colectomy rates among hospitalized patients with UC after anti-TNF therapy was introduced. METHODS We examined all patients discharged from the hospital between 2010 and 2014 with a primary diagnosis of UC or of complications of UC. The data were evaluated for race and colectomy rates among the hospitalized patients with UC. RESULTS The unadjusted national colectomy rate among hospitalized patients with UC between 2010 and 2014 was 3.90 per 1000 hospitalization days (95% confidence interval, 3.72-4.08). The undajusted colectomy rates in African American (2.33 vs 4.35; P < 0.001) and Hispanic patients (3.99 vs 4.35; P ≤ 0.009) were considerably lower than those for White patients. After adjustment for confounders, the incidence rate ratio for African American as compared to White patients was 0.43 (95% confidence interval, 0.32-0.58; P < 0.001). Geographic region of the United States also showed significant variation in colectomy rates, with western regions having the highest rate (4.76 vs 3.20; P < 0.001). CONCLUSIONS Racial and geographical disparities persist for the rate of colectomy among hospitalized patients with UC. The national database analysis reveals that colectomy rates for hospitalized African American and Hispanic patients were lower than those for White patients. Further studies are important to determine the social and biologic foundations of these disparities.
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Affiliation(s)
- Abhishek Bhurwal
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey, USA
| | - Carlos D Minacapelli
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey, USA
| | - Anish Patel
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey, USA
| | - Hemant Mutneja
- Division of Gastroenterology and Hepatology, John H. Stroger Cook County Hospital, Chicago, Illinois, USA
| | - Akshay Goel
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ishani Shah
- Department of Medicine, Creighton University St. Joseph Hospital, Phoenix, Arizona, USA
| | - Vikas Bansal
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bhaumik Brahmbhatt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Kiron M Das
- Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey, USA
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13
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Avalos DJ, Satiya J, Contreras A, Trivedi S, Alvarado L, Dodoo C, Dwivedi AK, Zuckerman MJ. Latin Americans and US Hispanics show differences in IBD phenotype: a systematic review with meta-analysis. J Investig Med 2021; 70:919-933. [PMID: 34933995 DOI: 10.1136/jim-2021-001846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/03/2022]
Abstract
Latin America has experienced a rise in the prevalence and incidence of inflammatory bowel disease (IBD). Differences in IBD phenotype between Hispanics in Latin America and those in the USA have not been described. We conducted a systematic review with meta-analysis of population-based and cohort studies comparing the phenotype of ulcerative colitis (UC) and Crohn's disease (CD) in Latin Americans and US Hispanics. A systematic search was conducted up to March 2019 using MEDLINE, EMBASE and Google Scholar. Inclusion criterion includes studies describing IBD phenotype in Latin Americans or in US Hispanics. Exclusion criterion includes prevalence or incidence studies not describing phenotype. A random effects model was chosen "a priori" for analysis of pooled proportions. A total of 46 studies were included from Latin America and 7 studies from the USA. The predominant IBD subtype in Latin America was UC with a more balanced UC:CD ratio noted in Puerto Rico (0.53) and Brazil (0.56). UC-related extensive colitis was more common in US Hispanics (0.64) than in Latin Americans (0.38), p<0.001. CD phenotype was similar between US Hispanics and Latin Americans. UC is the predominant IBD subtype in Latin America, with the exception of Puerto Rico and Brazil which demonstrate a more balanced UC:CD ratio. In UC, extensive colitis was more frequently seen in US Hispanics than in Latin Americans. CD phenotype was similar in both US Hispanics and Latin Americans.
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Affiliation(s)
| | - Jinendra Satiya
- Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alberto Contreras
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Shivani Trivedi
- Department of Internal Medicine, Largo Medical Center, Largo, Florida, USA
| | - Luis Alvarado
- Biostatistics and Epidemiology Consulting lab, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Christopher Dodoo
- Biostatistics and Epidemiology Consulting lab, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alok Kumar Dwivedi
- Department of Molecular and Translational Medicine, Division of Biostatistics & Epidemiology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Marc J Zuckerman
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
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Glover K, Mishra D, Singh TRR. Epidemiology of Ocular Manifestations in Autoimmune Disease. Front Immunol 2021; 12:744396. [PMID: 34795665 PMCID: PMC8593335 DOI: 10.3389/fimmu.2021.744396] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/14/2021] [Indexed: 01/19/2023] Open
Abstract
The global prevalence of autoimmune diseases is increasing. As a result, ocular complications, ranging from minor symptoms to sight-threatening scenarios, associated with autoimmune diseases have also risen. These ocular manifestations can result from the disease itself or treatments used to combat the primary autoimmune disease. This review provides detailed insights into the epidemiological factors affecting the increasing prevalence of ocular complications associated with several autoimmune disorders.
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Affiliation(s)
| | | | - Thakur Raghu Raj Singh
- School of Pharmacy, Medical Biology Centre, Queen’s University Belfast, Belfast, United Kingdom
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15
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Martins KR, Araújo JMD, Cruz ÁC, Luiz-Ferreira A. EPIDEMIOLOGIC ASPECTS OF INFLAMMATORY BOWEL DISEASE IN THE WESTERN REGION OF MINAS GERAIS STATE. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:377-383. [PMID: 34705974 DOI: 10.1590/s0004-2803.202100000-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Crohn's disease (CD) and ulcerative colitis (UC), two of the main inflammatory bowel diseases (IBD), have been increasingly diagnosed in South America. Although IBD have been intensively studied in the last years, epidemiologic data in Brazil are scarce. OBJECTIVE To study the clinical and epidemiologic profile of IBD patients treated in the Clinical Hospital of the Federal University of Uberlândia from 1999 to 2014. METHODS We performed a retrospective study of the medical records of patients diagnosed with IBD, according to the international classification of diseases (ICD) - ICD K50 for CD and ICD K51 for UC - confirmed by endoscopic examination in the case of both diseases. We analyzed the following variables: age; sex; ethnicity; smoking habit; primary diagnosis; site of disease manifestation; main clinical manifestations; IBD-related complications; extraintestinal manifestations; and established drug and/or surgical treatment. RESULTS We evaluated 183 IBD cases (91 UC and 92 CD cases). The estimated prevalence rate of UC was 15.06/100.000 inhabitants and of CD was 15.23/100.000. The CU and CD female to male incidence ratios were 1.7 and 1.8, respectively. The average age of patients diagnosed with UC was 39.4 years and of those diagnosed with CD was 31.1 years. White-skinned people were the most affected by UC (66.0%) and CD (69.0%). Few patients were submitted to surgical procedures as treatment alternative. CONCLUSION The estimated prevalence of IBD in this population was low compared to that of populations of North America, but high compared to that of other regions considered to present low incidence, such as some Asian and Latin American countries.
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Affiliation(s)
- Kamila Rosa Martins
- Universidade Federal de Uberlândia, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Uberlândia, MG, Brasil.,Universidade Federal de Catalão, Instituto de Biotecnologia, Departamento de Ciências Biológicas, Laboratório de Pesquisa em Doenças Inflamatórias Intestinais, Catalão, GO, Brasil
| | - Joniel Mendes de Araújo
- Universidade Federal de Catalão, Instituto de Biotecnologia, Departamento de Ciências Biológicas, Laboratório de Pesquisa em Doenças Inflamatórias Intestinais, Catalão, GO, Brasil
| | - Álefe Cardoso Cruz
- Universidade Federal de Catalão, Instituto de Biotecnologia, Departamento de Ciências Biológicas, Laboratório de Pesquisa em Doenças Inflamatórias Intestinais, Catalão, GO, Brasil
| | - Anderson Luiz-Ferreira
- Universidade Federal de Catalão, Instituto de Biotecnologia, Departamento de Ciências Biológicas, Laboratório de Pesquisa em Doenças Inflamatórias Intestinais, Catalão, GO, Brasil
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16
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Singh S, Proctor D, Scott FI, Falck-Ytter Y, Feuerstein JD. AGA Technical Review on the Medical Management of Moderate to Severe Luminal and Perianal Fistulizing Crohn's Disease. Gastroenterology 2021; 160:2512-2556.e9. [PMID: 34051985 PMCID: PMC8986997 DOI: 10.1053/j.gastro.2021.04.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The incidence and prevalence of Crohn's disease (CD) is rising globally. Patients with moderate to severe CD are at high risk for needing surgery and hospitalization and for developing disease-related complications, corticosteroid dependence, and serious infections. Optimal management of outpatients with moderate to severe luminal and/or fistulizing (including perianal) CD often requires the use of immunomodulator (thiopurines, methotrexate) and/or biologic therapies, including tumor necrosis factor-α antagonists, vedolizumab, or ustekinumab, either as monotherapy or in combination (with immunomodulators) to mitigate these risks. Decisions about optimal drug therapy in moderate to severe CD are complex, with limited guidance on comparative efficacy and safety of different treatments, leading to considerable practice variability. Since the last iteration of these guidelines published in 2013, significant advances have been made in the field, including the regulatory approval of 2 new biologic agents, vedolizumab and ustekinumab. Therefore, the American Gastroenterological Association prioritized updating clinical guidelines on this topic. To inform the clinical guidelines, this technical review was completed in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. The review addressed the following focused questions (in adult outpatients with moderate to severe luminal CD): overall and comparative efficacy of different medications for induction and maintenance of remission in patients with or without prior exposure to tumor necrosis factor-α antagonists, comparative efficacy and safety of biologic monotherapy vs combination therapy with immunomodulators, comparative efficacy of a top-down (upfront use of biologics and/or immunomodulator therapy) vs step-up treatment strategy (acceleration to biologic and/or immunomodulator therapy only after failure of mesalamine), and the role of corticosteroids and mesalamine for induction and/or maintenance of remission. Finally, in adult outpatients with moderate to severe fistulizing CD, this review addressed the efficacy of pharmacologic interventions for achieving fistula and the role of adjunctive antibiotics without clear evidence of active infection.
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Affiliation(s)
- Siddharth Singh
- Division of Gastroenterology and Division of Biomedical Informatics, Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Deborah Proctor
- Division of Gastroenterology, Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Frank I. Scott
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Yngve Falck-Ytter
- Division of Gastroenterology and Liver Disease, Case Western Reserve University, Cleveland, Ohio CA
| | - Joseph D. Feuerstein
- Division of Gastroenterology and Center for Inflammatory Bowel Diseases, Beth Israel Deaconess Medical Center, Boston, MA
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17
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Barnes EL, Loftus EV, Kappelman MD. Effects of Race and Ethnicity on Diagnosis and Management of Inflammatory Bowel Diseases. Gastroenterology 2021; 160:677-689. [PMID: 33098884 DOI: 10.1053/j.gastro.2020.08.064] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/07/2020] [Accepted: 08/15/2020] [Indexed: 02/07/2023]
Abstract
Although Crohn's disease (CD) and ulcerative colitis (UC) have been considered as disorders that affect individuals of European ancestry, the epidemiology of the inflammatory bowel diseases (IBDs) is changing. Coupled with the increasing incidence of IBD in previously low-incidence areas, the population demographics of IBD in the United States are also changing, with increases among non-White races and ethnicities. It is therefore important to fully understand the epidemiology and progression of IBD in different racial and ethnic groups, and the effects of race and ethnicity on access to care, use of resources, and disease-related outcomes. We review differences in IBD development and progression among patients of different races and ethnicities, discussing the effects of factors such as access to care, delays in diagnosis, and health and disease perception on disparities in IBD care and outcomes. We identify research priorities for improving health equity among minority patients with IBD.
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Affiliation(s)
- Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Michael D Kappelman
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Kudaravalli P, Tripathi N, Akanbi O, Yarra P, Abougergi M. Asians Have Higher Risk of Developing Pancreatic Necrosis in Inflammatory Bowel Disease Patient Population: A National Inpatient Sample Database Study. Cureus 2020; 12:e10573. [PMID: 33101817 PMCID: PMC7577300 DOI: 10.7759/cureus.10573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The aim of this study is to evaluate race-associated risk factors of acute pancreatitis (AP) in inflammatory bowel disease (IBD) patients. Methods A retrospective analysis using 2016 and 2017 National Inpatient Sample database was performed. Inclusion criteria were principal diagnosis of AP and a secondary diagnosis of IBD. Patients below 18 years of age were excluded. The primary outcome was in-hospital mortality rate and secondary outcomes included pancreatic necrosis, surgical necrosectomy, total hospitalization charges, total parenteral nutrition use, and length of stay. For the primary and secondary outcomes, adjusted odds ratios (aORs) and mean difference calculation using multivariate regression were calculated. Results A total of 7,060 patients with AP in IBD were identified; of which 53.5% were female. The use of Medicaid was significantly higher in blacks (39.5%), Hispanics (32.6%), and Asian/Pacific Islanders (40%) compared to whites (19.9%). Approximately 63.2% of AP patients in IBD received care at an urban teaching hospital. Pancreatic necrosis was noted to be highest in Asians or Pacific Islanders compared to whites (aOR 12.62, 95% CI 1.00-159.3, p = 0.05). Conclusion Our study shows that racial disparities exist among AP in IBD patients with pancreatic necrosis being more common in Asians and Pacific Islanders compared to whites. Identification of potential causes of these disparities is of paramount importance to expand access to healthcare.
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Herman AM, Hawkins AT, James SD, Ballard BR, M’Koma AE. Inflammatory Bowel Disease On-Line Web-Based Guide to Health Professionals and Patients in Developing and African Nations. JAPANESE JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 2020; 3:1165. [PMID: 37615012 PMCID: PMC10446829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Introduction 1.1.Inflammatory Bowel Disease (IBD) is recklessly evolving worldwide as incautious disaster, especially in developing nations as a regional duplicitous emergence disease. It has come to light that adaptive Western culture, rapid urbanization lifestyle in the developing nations has been seen to be associated with this increasing trend incidence. Apparent unclassified strategic challenge assessment of how key trends and uncertainties might lead the world over the next decades to help developing nations and plan for the long term. Healthcare professionals are faced with limited resource and unequipped laboratories for IBD diagnostics, prognostics and monitoring management. Limited knowledge on IBD among developing nation's physician's/healthcare providers is painstaking and indisputable challenge. With the emergence of advanced communications technology, the internet offers diverse, substantial, easily accessible, and educational resources that are more time- and cost-efficient than conventional modes of knowledge acquisition. An On-Line Web-Based Resources about IBD, as a guide would greatly assist health professionals and patients. Methods 1.2.We performed a literature search according to PRISMA-P (preferred reporting items for review and meta-analysis and searches in PubMed (MEDLINE database) to identify and select peer-reviewed articles allied to web-based educational accoutrements for IBD. Results 1.3.In developing nations, locally trained physicians have limited knowledge on IBD. Mostly, IBD is not included in their training Core Curriculum and research in this field/area is limited in these countries. The healthcare approaches, both at the primary care and referral levels, many times lack the essential regular clinical guidance and laboratory evaluation assessments needs for monitoring patients. Moreover, increasing treatment costs impose additional burden on the healthcare systems. Expensive pharmacological biosimilar and biologic agents/drugs, new treatment targets, and new quality indicators in patient health quality of life and care are significant challenge in addition to early manifestations of IBD are likely to be missed at most health institutions. Conclusion 1.4.We herewith summarize an on-line web-based e-learning guide for IBD-related educational resources to assist physicians, healthcare personnel and patients worldwide, especially in the developing nations where the epidemiological monitoring studies are limited, due to a lack of medical surveillance systems and reliable and unified registries and databases.
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Affiliation(s)
- AM Herman
- Department of General Surgery, Kilimanjaro Christian Medical Center (KCMC), Moshi, Kilimanjaro, Tanzania
| | - AT Hawkins
- Division of General Surgery, Section of Colon and Rectal Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - SD James
- Department of Pathology, Meharry Medical College School of Medicine, Nashville General Hospital, Nashville, Tennessee, United States
- Department of Pathology, Microbiology, and Immunology, Tennessee Valley Health Systems VA, Medical Center, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - BR Ballard
- Department of Pathology, Meharry Medical College School of Medicine, Nashville General Hospital, Nashville, Tennessee, United States
| | - AE M’Koma
- Division of General Surgery, Section of Colon and Rectal Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
- Department of Surgery and Surgical Sciences, Meharry Medical College School of Medicine, Nashville, Tennessee, United States
- The American Society of Colon and Rectal Surgeons (ASCRS), Arlington Heights, IL 60005, United States
- The American Gastroenterological Association (AGA), Bethesda, MD 20814, United States
- The International Society of Colon and Rectal Surgeons (ISUCRS), 109 Partin Street, Chapel Hill, NC 27514, United States
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Hispanic Americans and Non-Hispanic White Americans Have a Similar Inflammatory Bowel Disease Phenotype: A Systematic Review with Meta-Analysis. Dig Dis Sci 2018; 63:1558-1571. [PMID: 29594975 DOI: 10.1007/s10620-018-5022-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/13/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a devastating immune-mediated disease on the rise in Hispanics living in the USA. Prior observational studies comparing IBD characteristics between Hispanics and non-Hispanic whites (NHW) have yielded mixed results. AIMS We performed a meta-analysis of observational studies examining IBD phenotype in Hispanics compared to NHW. METHODS We conducted a systematic search of US-based studies comparing IBD subtype (Ulcerative Colitis: UC or Crohn's disease: CD) and phenotype (disease location and behavior) between Hispanics and NHW. We evaluated differences in age at IBD diagnosis, the presence of family history and smoking history. A random effects model was chosen "a priori." Categorical and continuous variables were analyzed using odds ratio (OR) or standard mean difference (SMD), respectively. RESULTS Seven studies were included with 687 Hispanics and 1586 NHW. UC was more common in Hispanics compared to NHW (OR 2.07, CI 1.13-3.79, p = 0.02). Location of disease was similar between Hispanics and NHW except for the presence of upper gastrointestinal CD, which was less common in Hispanics (OR 0.58, CI 0.32-1.06, p = 0.07). Hispanics were less likely to smoke (OR 0.48, CI 0.26-0.89, p = 0.02) or have a family history of IBD (OR 0.35, CI 0.22-0.55, p < 0.001). CD behavior classified by Montreal classification and age at IBD diagnosis were similar between Hispanics and NHW. CONCLUSION UC was more common among US Hispanics compared to NHW. Age at IBD diagnosis is similar for both Hispanics and NHW. For CD, disease behavior is similar, but Hispanics show a trend for less upper gastrointestinal involvement. A family history of IBD and smoking history were less common in Hispanics.
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Rackovsky O, Hirten R, Ungaro R, Colombel JF. Clinical updates on perianal fistulas in Crohn's disease. Expert Rev Gastroenterol Hepatol 2018; 12:597-605. [PMID: 29792734 DOI: 10.1080/17474124.2018.1480936] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Perianal fistulizing disease is an aggressive and debilitating phenotype of Crohn's disease (CD), representing a significant therapeutic challenge. New work has led to advancement in epidemiology and long-term outcomes of perianal disease. The range of therapeutic options continues to expand, including new biologic agents, biosimilars, and stem cell therapy. Areas covered: We discuss updates to all aspects of management of perianal disease, with a focus on the last 3 years of published data. Areas considered include new data on epidemiology and prognostication, medical and surgical therapy, and stem cell therapy. Expert commentary: The presence of perianal disease at CD diagnosis portends a significantly worse disease course. Patients with perianal disease require close monitoring to identify those who are at risk for worsening disease, suboptimal biologic drug levels, and signs of developing neoplasm. With the impending availability of local mesenchymal stem cell therapy, this becomes increasingly important as this therapy, although extremely promising, is thus far only effective in patients without proctitis.
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Affiliation(s)
- Ori Rackovsky
- a Department of Medicine, Division of Gastroenterology , Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Robert Hirten
- a Department of Medicine, Division of Gastroenterology , Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Ryan Ungaro
- a Department of Medicine, Division of Gastroenterology , Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Jean-Frederic Colombel
- a Department of Medicine, Division of Gastroenterology , Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai , New York , NY , USA
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22
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Proksell SS, Greer JB, Theisen BK, Davis PL, Rosh JR, Keljo DJ, Goyal A, Shah SA, Brand MH, Herfarth HH, Cross RK, Siegel CA, Koltun WA, Isaacs KL, Regueiro MD. IBD LIVE Case Series: Case 9: Do Race and Extraintestinal Manifestations Affect Treatment of Severe Crohn's Colitis? Inflamm Bowel Dis 2018; 24:698-713. [PMID: 29562279 DOI: 10.1093/ibd/izx114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Indexed: 12/09/2022]
Affiliation(s)
- Siobhan S Proksell
- Gastroenterology Fellow Year Iii, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Julia B Greer
- Assistant Professor of Medicine, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Brian K Theisen
- Assistant Professor of Pathology, Department of Pathology, George Washington University Hospital, Washington, D.C
| | - Peter L Davis
- Clinical Associate Professor of Radiology, Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joel R Rosh
- Director, Division of Gastroenterology and Nutrition, Goryeb Children's Hospital, Atlantic Health, Morristown, New Jersey.,Professor of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David J Keljo
- Interim Chief, Pediatric Gastroenterology, Hepatology, and Nutrition and Co-Director, Inflammatory Bowel Disease Center, Children's Hospital of Pittsburgh of Upmc, Pittsburgh, Pennsylvania.,Professor of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alka Goyal
- Associate Professor of Pediatrics, Director of Inflammatory Disease Service, Division of Gastroenterology, Hepatology and Nutrition, Children's Mercy Hospital, Kansas City, Missouri
| | - Samir A Shah
- Chief of Gastroenterology, The Miriam Hospital, Providence, Rhode Island.,Clinical Professor of Medicine, Warren Alpert School of Medicine At Brown University, Providence, Rhode Island
| | - Myron H Brand
- Clinical Professor of Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.,Medical Director, Shoreline Surgery Endoscopy Center, Connecticut Gastroenterology Consultants, New Haven, Connecticut
| | - Hans H Herfarth
- Professor of Medicine, Division of Gastroenterology and Hepatology, Co-Director Unc Multidisciplinary Center For Inflammatory Bowel Diseases, University of North Carolina, Chapel Hill, North Carolina
| | - Raymond K Cross
- Professor of Medicine, Director of Inflammatory Bowel Disease Program, University of Maryland School of Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Baltimore, Maryland
| | - Corey A Siegel
- Associate Professor of Medicine and of The Dartmouth Institute For Health Policy & Clinical Practice, Geisel School of Medicine At Dartmouth, Hanover, New Hampshire.,Director of The Inflammatory Bowel Disease Center At The Dartmouth-Hitchcock Medical Center In Lebanon, New Hampshire
| | - Walter A Koltun
- Chief, Division of Colon and Rectal Surgery, Milton S. Hershey Medical Center, Hershey, Pennsylvania.,Director, Hershey Penn State IBD Center, Professor of Surgery, Peter and Marshia Carlino Chair In IBD, Penn State College of Medicine, Hershey, Pennsylvania
| | - Kim L Isaacs
- Professor of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina
| | - Miguel D Regueiro
- Professor of Medicine, Associate Chief For Education, Co-Director, Inflammatory Bowel Disease Center, Head, IBD Clinical Program, Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Santos MPC, Gomes C, Torres J. Familial and ethnic risk in inflammatory bowel disease. Ann Gastroenterol 2017; 31:14-23. [PMID: 29333063 PMCID: PMC5759609 DOI: 10.20524/aog.2017.0208] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/21/2017] [Indexed: 02/07/2023] Open
Abstract
Familial aggregation in inflammatory bowel disease (IBD) has been established for several decades, reflecting shared genetic and environmental susceptibility. A positive family history remains the strongest recognizable risk factor for the development of IBD and is reported in around 8-12% of IBD patients. Crohn’s disease shows a more frequent familial pattern than ulcerative colitis. The risk of developing IBD in first-degree relatives of an affected proband is increased 4- to 8-fold. The risk for twins and children born from couples who both have IBD is also substantially higher; a cumulative effect of the number of family members affected has been described, with the highest incidence being described for families with three or more affected members. Herein, we review the available evidence regarding familial IBD, and briefly discuss the variation of IBD across different races and ethnicities, hoping to provide a useful update and a practical guide that can serve clinicians as a guide for counseling.
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Affiliation(s)
- Maria Pia Costa Santos
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Catarina Gomes
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Joana Torres
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
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24
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Race/Ethnicity-Specific Disparities in the Severity of Disease at Presentation in Adults with Ulcerative Colitis: A Cross-Sectional Study. Dig Dis Sci 2017; 62:2876-2881. [PMID: 28856475 DOI: 10.1007/s10620-017-4733-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/22/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND While ulcerative colitis (UC) is well studied in Caucasian populations, less data are available on UC patients of racial/ethnic minorities, including variations in disease severity at presentation. AIM To evaluate race/ethnicity-specific disparities in UC disease presentation among an ethnically diverse underserved population. METHODS We performed a cross-sectional study of all consecutive UC adults among a large ethnically diverse safety-net hospital from July 2014 to May 2016 to compare race/ethnicity-specific disparities in severity of disease at presentation. Severity was evaluated using the clinician-based simple clinical colitis activity index (SCCAI) and the Mayo score at time of presentation. Multivariate ordered logistic regression models were used to evaluate associations with SCCAI and Mayo scores. RESULTS Among 98 UC patients (56.1% male, mean age 40.1 (SD 14.2), 32.0% were African-American, 26.7% Hispanic, 16.0% Asian, and 20.0% Caucasian. Mean Mayo score was 6.6 and mean SCCAI score was 6.5. When stratified by race/ethnicity, SCCAI scores were significantly higher in non-Caucasians compared to Caucasians (7.0 vs 4.6, p = 0.03) and in Asians compared to Caucasians (8.0 vs 4.6, p = 0.02). There was a trend toward higher mean SCCAI in Hispanics compared to Caucasians (6.9 vs 4.6, p = 0.07). Mayo scores at presentation demonstrated similar trends. On multivariate logistic regression, Asians (OR 5.26, 95% CI 1.24-22.42) and Hispanics (OR 3.74; 95% CI 1.02-13.66) had more severe disease at presentation than Caucasians based on SCCAI. CONCLUSIONS Among a diverse underserved cohort of UC patients, racial/ethnic minority patients with UC, specifically Asians and Hispanics, had more severe disease at presentation compared to Caucasians. The differences may reflect disparities in timely access to specialty care and treatment and deserves greater attention and research.
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25
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Malaty HM, Lo GHW, Hou JK. Characterization and prevalence of spondyloarthritis and peripheral arthritis among patients with inflammatory bowel disease. Clin Exp Gastroenterol 2017; 10:259-263. [PMID: 29026327 PMCID: PMC5627736 DOI: 10.2147/ceg.s136383] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Joint complaints such as spondyloarthritis and peripheral arthritis are the most common extraintestinal manifestations in patients with inflammatory bowel disease (IBD); however, the evaluation of these symptoms are poorly described. Objectives To examine the clinical characteristics and prevalence of ankylosing spondylitis (AS) and other joint complaints among patients with IBD. Methods In a local cohort of patients diagnosed with IBD between 1996 and 2009, we performed a retrospective study at the Veterans Affairs Hospital. Patients with IBD were identified by International Classification of Diseases, Ninth Revision codes and confirmed by chart review. The occurrence of AS, peripheral arthritis, and other peripheral and axial joint symptoms were identified. Results We identified 626 patients with IBD between ages 18 and 90 (90% males), of whom 57% had ulcerative colitis (UC), 74% were Caucasians, and the mean age at diagnosis was 54 (±16) years. Among the study population, 108 patients (17%) had at least one type of joint pain. Among these 17% with joint pain, 12% had AS, 43% had peripheral arthritis, 32% had chronic back pain without AS, and 13% had other types of joint pain. The overall prevalence of peripheral arthritis among patients with IBD was three times higher than that of AS (7% vs 2.1%, respectively, OR 3.5; 95% confidence interval [CI] 1.9–6.5; p=0.001). There was no difference in the prevalence of AS or peripheral arthritis between patients with Crohn’s disease and UC. The initial diagnosis of AS occurred after the initial diagnosis of IBD in 80% of patients within a mean (SD) period of 5.6 (±6) years. Conclusion Spondyloarthritis among patients with IBD is usually diagnosed after the initial diagnosis of IBD. No difference in the prevalence of AS or peripheral arthritis was observed by IBD type, age, or race. Recognition and understanding of these results will have important implications for the management of IBD patients with spondyloarthritis.
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Affiliation(s)
- Hoda M Malaty
- Department of Medicine, Baylor College of Medicine.,Michael E DeBakey Veterans Affairs Medical Center
| | - Grace Hsiao-Wei Lo
- Department of Medicine, Baylor College of Medicine.,Michael E DeBakey Veterans Affairs Medical Center.,Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Jason K Hou
- Department of Medicine, Baylor College of Medicine.,Michael E DeBakey Veterans Affairs Medical Center.,Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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26
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Arsoniadis EG, Ho YY, Melton GB, Madoff RD, Le C, Kwaan MR. African Americans and Short-Term Outcomes after Surgery for Crohn's Disease: An ACS-NSQIP Analysis. J Crohns Colitis 2017; 11:468-473. [PMID: 27683803 PMCID: PMC5881719 DOI: 10.1093/ecco-jcc/jjw175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/30/2016] [Accepted: 09/27/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Previous reports on racial disparities in the treatment of Crohn's disease [CD] in African American [AA] patients have shown differences in both medical and surgical treatments in this population. No study thus far has examined the effect of AA race on outcomes after surgery for CD. METHODS Utilizing the National Surgical Quality Improvement Program [NSQIP] Participant User File [PUF] for the years 2005-2013, we examined the effect of AA race on postoperative complications in patients with CD undergoing intestinal surgery. RESULTS AA patients had a significantly higher rate of complications overall compared to non-AA patients [23.5% vs 18.9%, p = 0.002]. Postoperative sepsis [10.9% vs 6.6%, p < 0.001] and surgical site infection [17.6% vs 14.8%, p = 0.037] were most significant. After adjustment for age, sex, preoperative disease severity and lifestyle factors [smoking], race remained a statistically significant factor in postoperative complication rate. Only after additional adjustment was made for comorbidities and American Society of Anesthesiologists class did race lose significance within our model. CONCLUSION African Americans experience a greater amount of postoperative complications following surgery for Crohn's disease. Preoperative disease management, addressing smoking status and control of comorbid disease are important factors in addressing the racial disparities in the surgical treatment of Crohn's disease.
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Affiliation(s)
- Elliot G Arsoniadis
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yen-Yi Ho
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Genevieve B Melton
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Colon & Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert D Madoff
- Division of Colon & Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Chap Le
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mary R Kwaan
- Division of Colon & Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Racial and Ethnic Minorities with Inflammatory Bowel Disease in the United States: A Systematic Review of Disease Characteristics and Differences. Inflamm Bowel Dis 2016; 22:2023-40. [PMID: 27379446 DOI: 10.1097/mib.0000000000000835] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) has predominantly affected whites, particularly Ashkenazi Jews. Over the last 2 decades, IBD has "emerged" in minorities. Differences in natural history and disease characteristics have been suggested. The objective of this systematic review is to summarize these differences in studies from the United States. METHODS A structured search was performed within the Medline database through PubMed, EMBASE, and Cochrane databases. Published studies of genetics, pathogenesis, prevalence or incidence, disease location and behavior, extraintestinal manifestations, disparities and access to care in patients with IBD who are of African American, Asian, and Hispanic descent living in the United States were eligible. RESULTS A total of 47 studies were included for African Americans (n = 20,054), Hispanics (n = 10,762), and Asians (n = 2668). The incidence and prevalence of IBD is increasing among minorities. There is less of a genetic influence in the pathogenesis of IBD among African Americans; however, novel variants have been identified. There is a predilection for pancolonic ulcerative colitis among Hispanics and Asians. Crohn's disease-related hospitalizations are increasing in Asians, whereas African Americans are more likely to use the emergency department. No major differences are seen in disease location and behavior, upper gastrointestinal tract, and perianal involvement and extraintestinal manifestations among races and ethnic groups. Medication utilization seems to be similar. Differences in surgery are likely explained by health insurance status. CONCLUSIONS Future prospective studies are needed to fully characterize disease characteristics and treatment response among minorities. With novel IBD therapies in the pipeline, enrollment in clinical trials should emphasize increased representation of all races and ethnic groups.
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Abstract
BACKGROUND Immunomodulator and biological use in African Americans (AA) with Crohn's disease (CD) has been reported to be lower than in whites (W); less data exist for Hispanics (H). METHODS Medicaid databases from 3 states were examined for patients with CD from August 1998 to July 2009. CD-related treatments, comorbidities, location, surgery, and health care utilization were assessed from diagnosis until the first biological claim or end of claims. A Cox proportional hazard regression model was used to assess the effect of race on biological initiation. RESULTS A total of 5575 patients with CD (3590 W; 924 AA; 494 H; and 567 "other") were analyzed; 18%, 17%, and 17% of W, AA, and H patients, respectively, started immunomodulators (P = not significant); and 7%, 9%, and 5% of W, AA, and H, respectively, initiated biologics after CD diagnosis (P = not significant). After adjusting for demographics and CD-related medications and comorbidities in Cox models, no association was found between AA and W for biological use (hazard ratio 1.19; 95% confidence interval [CI], 0.91-1.54) or H and W (hazard ratio 0.68, 95% CI, 0.45-1.02). Analyzing patients hospitalized after CD diagnosis (n = 3428) to adjust for disease severity demonstrated that H were significantly less likely to use biologics than W (hazard ratio 0.40, 95% CI, 0.22-0.74). No differences between W and AA were found. CONCLUSIONS Our findings suggest that differences between AA and W in exposure to immunomodulators or biologics may not exist, although they may be present in H with more severe disease. Further research is needed to confirm these findings.
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Malaty HM, Sansgiry S, Artinyan A, Hou JK. Time Trends, Clinical Characteristics, and Risk Factors of Chronic Anal Fissure Among a National Cohort of Patients with Inflammatory Bowel Disease. Dig Dis Sci 2016; 61:861-4. [PMID: 26514675 DOI: 10.1007/s10620-015-3930-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 10/12/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Chronic anal fissure (CAF) is a common problem that causes significant morbidity. Little is known about the risk factors of CAF among patients with inflammatory bowel disease (IBD). AIM To study the clinical characteristics and prevalence of CAF among a cohort of IBD patients. METHODS We performed a population-based study on IBD patients from the National Veterans Affairs administrative datasets from 1998 to 2011. IBD and AF were identified by ICD-9 diagnosis codes. RESULTS We identified 60,376 patients with IBD between the ages of 18-90 years, 94% males, 59% diagnosed with ulcerative colitis (UC), and 88% were Caucasians. The overall prevalence of CAF was 4% for both males and females. African Americans (AA) were two times more likely to have CAF compared to Caucasians (8 vs. 4%; OR 2.0, 95% CI 1.6-20.2, p = 0.0001) or Hispanics (8 vs. 4.8%; OR 2.1, 95% CI 1.4-25.2, p = 0.0001). The prevalence of CAF significantly dropped with age from 7% at age group 20-50 to 1.5% at 60-90 (p = 0.0001). CD patients were two times more likely to have CAF than UC patients (6 vs. 3%; OR 1.9, 95% CI 1.5-18.2, p = 0.0001). The initial diagnosis of CAF occurred within 14 years after the initial diagnosis of IBD in 74.5% patients. CONCLUSIONS CAF is more prevalent among IBD than what is reported in the general population and diagnosed after the diagnosis of IBD. CAF is more prevalent among patients with CD, younger patients, and AA. The current results lay the groundwork for further outcome studies relate to anal fissure such as utilization, hospitalization, and cost.
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Affiliation(s)
- Hoda M Malaty
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Shubhada Sansgiry
- VA HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Avo Artinyan
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Jason K Hou
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,VA HSR&D Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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Abstract
BACKGROUND Historically, inflammatory bowel disease (IBD) was considered a disease, which predominately affects whites. As such, the majority of research in IBD has been conducted in this population. However, more research on this suggests that IBD affects other ethnic groups. Rapidly shifting demographics in the United States necessitates a better understanding of how IBD may affect Hispanics. We reviewed the current literature on IBD in Hispanics. METHODS A PubMed search was conducted using keywords inflammatory bowel disease, Ulcerative Colitis, Crohn's disease, Hispanics, Latinos, ethnicity, to identify existing literature with a focus on adult populations. Non-English language articles were excluded. RESULTS The existing data and literature on Hispanic patients with IBD remains sparse. Limited studies on prevalence suggest IBD may be more common in Hispanics in the United States compared with those in Latin America. Conflicting data exist as to whether Hispanics patients with IBD are more likely to have ulcerative colitis compared with Crohn's disease. One study explored difference in IBD between foreign-born and U.S.-born Hispanics and found that ulcerative colitis was more common only in foreign-born Hispanics, whereas within 1 generation, U.S.-born Hispanics resemble their non-Hispanic white counterparts about development of Crohn's disease. Such a rapid change in the proportion of ulcerative colitis and Crohn's disease points strongly to environmental factors driving the change in proportion of disease subtypes. Additionally, a trend towards less use of biologic and immunomodulators in Hispanics was noted in several studies. CONCLUSIONS Additional research is needed to better understand how diversity within the Hispanic population (U.S.-born and foreign-born) may be driving difference in disease manifestations. More investigations should focus on determining the cause of a potential disparity in the use of biologic and immunomodulators in Hispanics.
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Affiliation(s)
- Lakshmi D N Lattimer
- Department of Medicine, Division of Gastroenterology, George Washington University, Washington, DC
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Dotson JL, Kappelman MD, Chisolm DJ, Crandall WV. Racial disparities in readmission, complications, and procedures in children with Crohn's disease. Inflamm Bowel Dis 2015; 21:801-8. [PMID: 25742396 PMCID: PMC4366277 DOI: 10.1097/mib.0000000000000325] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Racial disparities in care and outcomes contribute to mortality and morbidity in children; however, the role in pediatric Crohn's disease is unclear. In this study, we compared cohorts of black and white children with Crohn's disease to determine the extent race is associated with differences in readmissions, complications, and procedures among hospitalizations in the United States. METHODS Data were extracted from the Pediatric Health Information System (January 1, 2004-June 30, 2012) for patients with 21 years or younger hospitalized with a diagnosis of Crohn's disease. White and black cohorts were randomly selected in a 2:1 ratio by hospital. The primary outcome was time from index hospital discharge to readmission. The most frequent complications and procedures were evaluated by race. RESULTS There were 4377 patients. Black children had a shorter time to first readmission and higher probability of readmission (P = 0.009) and a 16% increase in risk of readmission compared with white children (P = 0.01). Black children had longer length of stay and higher frequency of overall and late (30-d to 12-mo postdischarge) readmissions (P < 0.001). During index hospitalization, more black children had perianal disease and anemia (P < 0.001). During any hospitalization, black children had higher incidence of perianal disease, anemia, and vitamin D deficiency, and greater number of perianal procedures, endoscopies, and blood product transfusion (P < 0.001). CONCLUSIONS There are differences in hospital readmissions, complications, and procedures among hospitalized children related to race. It is unclear whether these differences are due to genetic differences, worse intrinsic disease, adherence, access to treatment, or treatment disparities.
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Affiliation(s)
- Jennifer L. Dotson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, Columbus, OH
- The Center for Innovation in Pediatric Practice, The Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Michael D. Kappelman
- University of North Carolina at Chapel Hill, Department of Pediatrics, Division of Gastroenterology and Hepatology, Chapel Hill, NC
| | - Deena J. Chisolm
- The Center for Innovation in Pediatric Practice, The Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Wallace V. Crandall
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, Columbus, OH
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Abstract
BACKGROUND There is increasing recognition of Crohn's disease (CD) in non-white populations. However, reports of racial disparities in the phenotype of CD are still inconsistent. AIM : The aim of this study was to test the hypothesis that African American (AA) patients have higher incidence of severe fistulizing perianal Crohn's disease (FPD) compared with white patients. METHODS Cross-sectional analysis of 333 adult CD patients treated at The Mount Sinai Hospital with infliximab between May 2011 and December 2011 was conducted. Self-reported race/ethnicity was recorded and proportions of each group with FPD were compared across the population. RESULTS Among all 333 evaluable CD patients on infliximab, 73.6% were white, 11.4% AA, 13.2% Hispanic, and 1.8% Asian. Of these 333 patients, 88 had FPD: only 48 of these (54.5%) were white, whereas fully 18 (20.5%) were AA, 20 (22.7%) were Hispanic, and 2 (2.3%) were Asian. Thus, patients receiving infliximab for FPD were significantly more likely to be AA or Hispanic than white (AA vs. whites: risk ratio=2.63; 95% confidence interval, 1.74-3.96; P=<0.0001; Hispanics vs. whites: risk ratio=2.32; 95% confidence interval, 1.54-3.50; P=0.0001). There was no statistically significant difference between AA and Hispanics. CONCLUSION CD patients at our medical center with FPD requiring infliximab therapy were significantly more likely to be AA or Hispanic.
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Higgins PDR, Skup M, Mulani PM, Lin J, Chao J. Increased risk of venous thromboembolic events with corticosteroid vs biologic therapy for inflammatory bowel disease. Clin Gastroenterol Hepatol 2015; 13:316-21. [PMID: 25038374 DOI: 10.1016/j.cgh.2014.07.017] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 06/10/2014] [Accepted: 07/02/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We investigated whether treatment of active inflammatory bowel disease with biologic agents is associated with a reduced risk of venous thromboembolic events (VTEs) compared with corticosteroid therapy. METHODS We performed a retrospective analysis of 15,100 adults with inflammatory bowel disease who were identified from the Truven Health MarketScan databases. We analyzed data from patients who received 6 months of continuous medical and prescription coverage before and 12 months after their first diagnosis and had no VTE during the 6 months before they first received biologic or corticosteroid therapy. The outcome assessed was any VTE that occurred during the 12-month follow-up period. A multivariate logistic regression model was used to evaluate the effects of biologic, corticosteroid, and combination therapies (biologics and corticosteroids) on VTE risk. RESULTS Three hundred twenty-five VTEs occurred during the study period (in 2.25% of patients receiving only corticosteroids, in 0.44% of patients receiving biologics, and in 2.49% of patients receiving combination therapy). Compared with patients receiving only corticosteroids, the odds ratio for VTE in patients receiving only biologics was 0.21 (95% confidence interval, 0.05-0.87) in the multivariate model, and the odds ratio for VTE in patients on combination therapy was 1.01. CONCLUSIONS Compared with treatment with only a biologic agent, corticosteroid therapy is associated with a nearly 5-fold increase in risk for VTE. Combination therapy with corticosteroids and biologic agents was associated with the same risk for VTE as that of corticosteroids alone. Corticosteroids therefore appear to increase risk for VTE.
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Affiliation(s)
- Peter D R Higgins
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
| | - Martha Skup
- Global Health Economics and Outcomes Research, AbbVie Inc, North Chicago, Illinois
| | - Parvez M Mulani
- Global Health Economics and Outcomes Research, AbbVie Inc, North Chicago, Illinois
| | - Jay Lin
- Novosys Health, Flemington, New Jersey
| | - Jingdong Chao
- Global Health Economics and Outcomes Research, AbbVie Inc, North Chicago, Illinois
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Parente JML, Coy CSR, Campelo V, Parente MPPD, Costa LA, Silva RMD, Stephan C, Zeitune JMR. Inflammatory bowel disease in an underdeveloped region of Northeastern Brazil. World J Gastroenterol 2015; 21:1197-1206. [PMID: 25632193 PMCID: PMC4306164 DOI: 10.3748/wjg.v21.i4.1197] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/09/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the demographic characteristics and clinical phenotypes of inflammatory bowel disease (IBD) in a geographic area in Northeastern Brazil.
METHODS: This retrospective study was conducted at the Hospital of the Federal University of Piauí in Northeastern Brazil. Demographic characteristics and clinical phenotypes of IBD were analyzed in relation to the time of diagnostic confirmation, which was defined as the date of disease onset. Data were collected between January 2011 and December 2012 and included all census patients 18 years of age or older during that period for whom there was diagnostic confirmation of Crohn’s disease (CD), ulcerative colitis (UC), or unclassified colitis according to the Montreal criteria. We also analyzed the period of time between the onset of clinical manifestations and the diagnosis of IBD (delay in the diagnosis). Statistical analyses included means and standard deviations for numeric variables and the Pearson χ2 adherence test for nominal variables. The annual index occurrence and overall prevalence of IBD at our institution were also calculated, with P values < 0.05 indicating statistical significance. This study was approved by the Institutional Ethics and Research Committee.
RESULTS: A total of 252 patients with IBD were included, including 152 (60.3%) UC patients and 100 (39.7%) CD patients. The clinical and demographic characteristics of all patients with IBD showed a female to male ratio of 1.3:1.0 and a mean age of 35.2 (SD = 14.5) years. In addition, the majority of patients were miscegenated (171, 67.9%), had received higher education (157, 62.4%), lived in urban areas (217, 86.1%), and were under the age of 40 years (97, 62.5%). For patients with CD, according to the Montreal classification, the predominant features present from the onset of disease were an age between 17 and 40 years (A2); colonic disease location (L2); and nonstricturing, nonfistulizing disease behavior (B1). However, approximately one-quarter of all CD patients demonstrated perineal involvement. We also observed considerable delay in the diagnosis of IBD throughout the entire study period (mean = 35.5 mo). In addition, the annual index occurrence rose from 0.08 to 1.53 cases/105 inhabitants/year during the study period, and the prevalence rate was 12.8 cases/105 inhabitants in 2012. Over the last two decades, there was a noted increase in the frequency of IBD in the study area.
CONCLUSION: In this study, there was a predominance of patients with UC, young people under 40 years of age, individuals with racial miscegenation, and low annual incomes.
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Sofia MA, Rubin DT, Hou N, Pekow J. Clinical presentation and disease course of inflammatory bowel disease differs by race in a large tertiary care hospital. Dig Dis Sci 2014; 59:2228-35. [PMID: 24752402 PMCID: PMC4180597 DOI: 10.1007/s10620-014-3160-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 04/08/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND While the incidence of inflammatory bowel disease (IBD) among African-Americans (AAs) is increasing, there is limited understanding of phenotypic differences and outcomes by race. AIM To describe disease characteristics of AA patients compared to Caucasian (Ca) patients in a tertiary care population. METHODS We performed a cross-sectional review of the IBD registry at the University of Chicago from January 2008 to January 2013. Data regarding race, phenotype, disease onset, disease duration, medical therapy, and surgical treatment were abstracted from the database, then compared via Pearson's chi-square analysis, Kruskal-Wallis analysis, and logistic regression with a significance level of p < 0.05. RESULTS A total of 1,235 patients with Crohn's disease (CD) and 541 patients with ulcerative colitis (UC) included 108 AA CD patients and 28 AA UC patients. AA CD patients had an increased rate of IBD-related arthralgias (36.5 vs. 23.9 %, p < 0.01) and surgery (p < 0.01), less ileal involvement (57.8 vs. 71.0 %, p < 0.01), and no differences for other extraintestinal manifestations or disease locations compared to Ca CD patients. AA UC patients were older at diagnosis, had an increased rate of arthralgias (28.6 vs. 14.6 %, p = 0.047) and ankylosing spondylitis/sacroiliitis (7.1 vs. 1.6 %, p = 0.035), with no differences for disease extent or rate of IBD-related surgeries compared to Ca UC patients. There were no differences in medication usage by race for CD and UC patients. CONCLUSION We identified significant differences in disease characteristics and extraintestinal manifestations between AA and Ca IBD patients in a large tertiary care population. These results have implications for future genotype-phenotype studies.
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Affiliation(s)
- M. Anthony Sofia
- Department of Medicine, University of Chicago, Chicago, IL, USA. 5841 S. Maryland Avenue, MC 7082, Chicago, IL 60637, USA
| | - David T. Rubin
- Department of Medicine, University of Chicago, Chicago, IL, USA. Inflammatory Bowel Disease Center, University of Chicago, Chicago, IL, USA. 5841 S. Maryland Avenue, MC 4076, Chicago, IL 60637, USA
| | - Ningqi Hou
- Department of Health Studies, University of Chicago, Chicago, IL, USA. 5841 S. Maryland Avenue, MC 2007, Chicago, IL 60637, USA
| | - Joel Pekow
- Department of Medicine, University of Chicago, Chicago, IL, USA. Inflammatory Bowel Disease Center, University of Chicago, Chicago, IL, USA. 900 East 57th St., MB #9, Chicago, IL 60637, USA
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Griglione N, Yarandi S, Srinivasan J, Ahearn T, Dhere T. A comparison of abdominal surgical outcomes between African-American and Caucasian Crohn's patients. Int J Colorectal Dis 2014; 29:917-22. [PMID: 24828990 DOI: 10.1007/s00384-014-1902-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Whether race affects the natural history of Crohn's disease is a matter of debate. The aim of the current study was to evaluate the differences in surgical outcomes between African-American (AA) and Caucasian (C) Crohn's patients undergoing surgery at a tertiary care referral center. METHODS With Institutional Review Board approval, the medical records of our institution were queried to identify consecutive AA and C patients who underwent surgery for Crohn's disease from December 1, 2009 to December 15, 2011. A retrospective chart review was performed using electronic medical records. RESULTS A total of 77 patients were included in this study, including 32 AA (41 %) and 45 C (59 %). No significant differences were seen with respect to age, gender, type of insurance, preoperative exposure to immunosuppressives, body mass index, or smoking history between the two populations (p > 0.05). There was a trend toward lower albumin in AAs (p = 0.09). AA and C patients who underwent their first Crohn's disease (CD)-related surgery had similar lag periods between diagnosis and surgery. No significant differences were seen in location of disease, indication for operation, and need for open laparotomy over laparoscopy. No significant differences were seen in need for a repeat operation within 90 days of the original surgery or major postoperative complications. There was a trend toward higher rate of minor complications in the AA group (p = 0.07). CONCLUSION No significant differences were noted in the current study in several preoperative variables and surgical outcomes between AA and C.
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Affiliation(s)
- Nicole Griglione
- Department of Medicine, Emory University, 1365 Clifton Road, NE Building B, STE 1200, Atlanta, GA, 30322, USA,
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Hwang C, Velayos F. On the question of ethnicity and its impact on IBD-related outcomes. Dig Dis Sci 2014; 59:19-21. [PMID: 24282056 DOI: 10.1007/s10620-013-2951-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 11/11/2013] [Indexed: 12/09/2022]
Affiliation(s)
- Caroline Hwang
- Division of Gastrointestinal and Liver Diseases, University of Southern California, Los Angeles, CA, USA
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The effects of race and socioeconomic status on immunomodulator and anti-tumor necrosis factor use among ambulatory patients with inflammatory bowel disease in the United States. Am J Gastroenterol 2013; 108:1824-30. [PMID: 24300857 DOI: 10.1038/ajg.2013.192] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Health-care disparities exist for patients of minority race and low socioeconomic status (SES) in many chronic disease states, but little is known regarding health-care disparities for patients with inflammatory bowel disease (IBD). Using nationally representative data, we sought to determine whether use of immunomodulators and anti-tumor necrosis factor (TNF) agents differed by race/ethnicity and SES among ambulatory patients with IBD. METHODS We used data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 1998 to 2010. We identified visits associated with IBD and the medications associated with those visits. Race/ethnicity and SES were characterized. The frequency of immunomodulator and anti-TNF use over time was assessed. We performed analyses accounting for the survey's complex multistage probability sampling design. Associations between race/ethnicity, SES and IBD medication use were identified. RESULTS A total of 26,400,000 visits for patients with IBD occurred in the United States from 1998 to 2010. Seventy-six per cent of visits were for whites, 9% were for blacks, 7% were for Hispanics, and 2% were for Asians. Sixty-one per cent of visits were privately insured, whereas 7% had Medicaid coverage. From 1998 to 2010, the proportion of visits associated with immunomodulators increased from 6 to 13%, whereas the proportion associated with anti-TNF agents increased from <1 to 14%. In adjusted analyses, visits with Medicaid were three times more likely to be associated with immunomodulators than visits with private insurance, but there were no race/ethnicity-based differences in immunomodulator use. There were no race/ethnicity- or SES-based differences in anti-TNF therapy. CONCLUSIONS Using nationally representative data over a 13-year time period, we found no evidence of disparities in medical therapy for IBD among visits with minority race/ethnicity or low SES.
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Sewell JL, Velayos FS. Systematic review: The role of race and socioeconomic factors on IBD healthcare delivery and effectiveness. Inflamm Bowel Dis 2013; 19:627-43. [PMID: 22623078 PMCID: PMC3905682 DOI: 10.1002/ibd.22986] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Race and socioeconomic status (SES) significantly affect the content and delivery of healthcare for multiple chronic disease states. Inflammatory bowel disease (IBD) is a set of complex, chronic diseases with the potential for significant morbidity if the content or delivery of healthcare is suboptimal. However, the literature related to race, SES, and IBD remains fragmented. METHODS Using guidelines published by the Centre for Reviews and Dissemination, we performed a systematic review of the world's literature to identify studies related to: 1) IBD, 2) race/ethnicity, 3) SES, 4) healthcare delivery, and 5) healthcare effectiveness. RESULTS We identified 40 studies that met inclusion criteria. Twenty-four studies (60%) assessed the role of SES and 21 (53%) evaluated race. Topics addressed by these studies included: 1) Utilization of Medical and Surgical Therapy; 2) Adherence to Medical Therapy; 3) Clinical Outcomes; 4) Healthcare Access and Utilization; 5) Disease Perception and Knowledge; and 6) Employment/Insurance. We identified race- and SES-based disparities in the content of medical and surgical healthcare, utilization of inpatient and ambulatory medical care, adherence to medical therapy, and disease perceptions and knowledge. Several studies also identified race- and SES-based disparities in outcomes for IBD, including in-hospital mortality rates and health-related quality of life. CONCLUSIONS Race- and SES-based disparities in the delivery and effectiveness of healthcare for patients with IBD exist in numerous domains, yet studies remain limited in their scope and breadth. Concerted, prospective, multicenter efforts are needed to address underlying causes for disparities and to identify methods of reducing and eliminating disparities.
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Affiliation(s)
- Justin L. Sewell
- Center for Innovation in Access and Quality, Division of Gastroenterology and Hepatology, San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Fernando S. Velayos
- Center for Crohn's and Colitis, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California
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Damas OM, Jahann DA, Reznik R, McCauley JL, Tamariz L, Deshpande AR, Abreu MT, Sussman DA. Phenotypic manifestations of inflammatory bowel disease differ between Hispanics and non-Hispanic whites: results of a large cohort study. Am J Gastroenterol 2013; 108:231-9. [PMID: 23247580 DOI: 10.1038/ajg.2012.393] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Hispanics are the fastest growing minority in the United States, yet few studies have examined the phenotypes of inflammatory bowel disease (IBD) in this population. No studies compare IBD presentation between foreign and US-born Hispanics. Our aim was to compare phenotypic characteristics of IBD between Hispanics and non-Hispanic Whites (NHWs), as well as between US-born and foreign-born Hispanics. METHODS We retrospectively identified cohorts of adult IBD patients from 1998 to 2009 and compared ethnic variation in phenotype, including disease type (Crohn's disease or ulcerative colitis (UC)), extra-intestinal manifestations (EIMs), Montreal classification, surgeries, hospitalizations, and medication prescription. RESULTS A total of 325 patients were included; 208 were Hispanics. Foreign-born Hispanics, accounting for 68% of the total, were diagnosed at an older age than US-born Hispanics and NHWs (45 vs. 25 and 27, respectively, P<0.05). Foreign-born Hispanics manifested more UC than US-born Hispanics or NHWs (59.9% vs. 41% and 28.2%, respectively, P<0.05). No difference was noted in the prevalence of EIMs between Hispanics and NHWs. More upper gastrointestinal tract Crohn's was observed in NHWs (12.5% vs. 3.9%, P<0.05). The incidence density rate of IBD-related surgeries in NHWs was higher than in Hispanics (22.9 vs. 7.3 surgeries/100 person-years, P<0.01, hazard ratio: 0.3, 95% confidence interval: 0.14-0.5). Hispanic patients had fewer prescriptions for biologics and immunomodulators than NHWs (22.2% vs. 55.6%, P<0.01 and 35.7% vs. 53.8%, P<0.01, respectively). CONCLUSIONS This study demonstrates differences in IBD presentation among NHW, US-born Hispanic, and foreign-born Hispanic groups. Further investigation to identify environmental and genetic differences between ethnic groups affected by IBD is warranted.
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Affiliation(s)
- Oriana M Damas
- Department of Medicine, Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, Florida 33101, USA
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Ferrara LR, Saccomano SJ. Crohn disease: recognition is key. Nurse Pract 2012; 37:22-29. [PMID: 23114717 DOI: 10.1097/01.npr.0000422202.95229.a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Crohn disease (CD) is an autoimmune disease that affects people across the lifespan. Patients with CD are predisposed to other autoimmune illnesses, such as psoriasis or arthritis, and suffer from complications including infection and malnutrition. This article will focus on the diagnosis and treatment of CD.
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Affiliation(s)
- Lucille R Ferrara
- Family Nurse Practitioner Program, Pace University, College of Health Professions, Pleasantville, NY, USA
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Abstract
OBJECTIVES Certain diagnostic radiology procedures may expose patients with inflammatory bowel disease (IBD) to radiation and increase the risk for cancer. In the present study, we quantify the acute and cumulative effective dose of diagnostic radiation received by a cohort of pediatric patients with IBD. PATIENTS AND METHODS Patients with IBD were identified from the medical records of a pediatric tertiary care center. The number and type of radiology procedures for each patient were determined from medical record review. Cumulative effective radiation dose was calculated using radiation effective dose estimates. RESULTS One hundred five patients with IBD underwent radiation-associated abdominopelvic diagnostic radiology procedures with an average cumulative radiation exposure dose of 15 (18) [mean (SD)] mSv. Forty-two percent of the patients were exposed to acute radiation doses ≥10 mSv, and 6 patients (6%) were exposed to levels of cumulative radiation exposure ≥50 mSv, which has been associated with an increased risk of cancer development. Patients with Crohn disease, an increased number of hospital admissions, and a history of surgery were more likely to have been exposed to higher levels of cumulative radiation than their clinical counterparts. CONCLUSIONS A majority of patients with IBD are exposed to radiation from typical diagnostic radiology procedures. Radiation-sparing procedures should be strongly considered in certain pediatric patients with IBD to reduce their risk for cancer given an already present increased lifetime malignancy potential.
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