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Race Differences in IBD: A Study of Quality of Life, Work Productivity, and Endoscopic Severity


Jiang, Chunsu MD1; Alfa, David MBBS, MPH1; Gardner, Doree MS1; Dhere, Tanvi MD2; Iskandar, Heba MD, MPH2

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American Journal of Gastroenterology: October 2018 - Volume 113 - Issue - p S656-S657
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Introduction: Over the past 2 decades there has been an increase in the incidence and prevalence of IBD in African Americans (AA) as well as other minority groups. Studies have suggested racial differences in disease behavior and extraintestinal manifestations in IBD. However, limited data exists on racial differences of IBD in terms of patient's quality of life. We aimed to evaluate differences between AA and Caucasian IBD patients in terms of quality of life, work productivity, and disease perception.

Methods: We performed a prospective cohort study (2015-2017) in a single tertiary referral center. Patients with IBD were recruited on day of colonoscopy. Patients were given a survey containing demographics, socioeconomic information, Harvey Bradshaw Index (HBI), Simple colitis activity index (SCAI), Hospital Anxiety and Depression Score (HADS), The Short inflammatory bowel disease questionnaire (SIBDQ), Work Productivity and impairment score (WPAI) and 36-Item Short Form Health Survey (SF36). Patients subsequently underwent colonoscopy and endoscopic scores: SES-CD, Mayo Score were recorded for endoscopic disease severity. Statistical analysis included Chi square, Fisher's exact test for categorical variables, Mann Whitney U and 2 sample T-test for continuous variables.

Results: Eighty-six patients, 22 AA (12 CD, 10 UC) and 64 Caucasians (34 CD, 26 UC). Baseline age, sex and socioeconomic factors (marital status, educational status, employment and income) between the two races are similar (Table 1). There were no differences in SIDBQ, HADS, SF36 physical and mental component summaries, HBI, SCAI between the two groups. AA, when compared to Caucasians, showed a significantly higher percentage of work missed due to health (7.1% vs 1.37%, and P = 0.03). In Crohn's patients, while there is no difference between AA and W in terms of HBI, AA patients had significantly worse SES-CD scores on endoscopy (11.36 vs 5.9, P = 0.037). This disparity was not observed in UC.

1144_A Figure 1. Socioeconomic analyses between AA vs W and M vs F
1144_B Figure 2. AA vs W, M vs F in various measures of quality of life, clinical disease activity and endoscopic scores.

Conclusion: Overall measures of quality of life are similar between AA and Caucasian IBD patients. However, we observed higher percentage of work missed due to IBD in AA patients despite similar clinical disease severity. AA Crohn's patients showed significantly worse endoscopic scores despite having similar clinical disease activity compared to Caucasian patients. Further studies are needed to determine the reasons for these differences and suggest interventions to improve AA IBD patients' work productivity.

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