Effects of Race and Ethnicity on Diagnosis and Management of Inflammatory Bowel Diseases

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.

AGA Technical Review on the Medical Management of Moderate to Severe Luminal and Perianal Fistulizing Crohn’s Disease

“…Similarly, racial and ethnic minorities, including African American and Hispanic populations, and immigrants have traditionally been underrepresented in clinical trials. 138 Prior studies have demonstrated lower use of advanced medical and surgical therapies, inferior health care access, lower adherence to therapy, and inferior IBD-related outcomes in these patients. Therefore, a more comprehensive understanding of disease burden, course and treatment effectiveness, and access is warranted in these patients.…”

“…A recent review on the effects of race and ethnicity on the management of IBD patients highlights issues around access to care, insurance coverage, and use of medical therapies, specifically biologic agents. 138 Although some studies demonstrated that African American, Asian, or Hispanic patients with CD were less likely to receive biologics compared with White patients, other studies found no differences in the use of immunomodulators of TNFa antagonists among patients of different races or ethnicities. [139][140][141] There is evidence of differences in insurance coverage, however, with African American and Hispanic populations less likely to have commercial insurance and more likely to have Medicaid or be uninsured.…”

Roles of Adipokines in Digestive Diseases: Markers of Inflammation, Metabolic Alteration and Disease Progression

“…The exact etiopathogenesis of IBD remains unknown, while potential factors involve genetic predisposition, environmental conditions, and immunological dysfunctions. The main IBDs are ulcerative colitis (UC) and Crohn's disease (CD) [198]. Although transmural inflammation in CD may affect any part of the gastrointestinal tract, it occurs most frequently in the terminal ileum or the large intestine.…”

Emerging Comorbidities in Inflammatory Bowel Disease: Eating Disorders, Alcohol and Narcotics Misuse

“…The occurrence of IBD is increasing worldwide and they are no longer diseases of the Western countries [ 6 ]. Based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, between 1990 and 2017 the number of individuals with IBD increased from 3.7 million to more than 6.8 million (3.9 million females and nearly 3 million males) globally.…”