Abstract

Background: Crohn’s disease (CD) is a complex entity, but most studies contain predominately non-African Americans from IBD focused practices. Further studies with diverse population are needed.
Aims: This study compares African American (AA) to non-African Americans in a general GI clinic, to assess racial disparities in disease manifestation, surgery, and therapy.
Methods: CD patients (n=136) with at least one visit between 2018 and 2020 at Wayne Health in Detroit, MI were identified. Variables obtained included endoscopic evaluations, CD relevant surgical procedures, medical therapies, medical insurance, and median income by zip code.
Results: AA patients presented with higher CRP prior to initiation of therapy, compared to non-AA patients (34 mg/L vs 20 mg/L, p = 0.048). Most surgeries occurred prior to diagnosis and treatment (90%) and were endoscopically evaluable (i.e. 95% not small bowel resections). AA patients with CD were less likely to be compliant with respect to regular visits and medication adherence as compared to non-AA (50% vs 84% p<0.005). AA patients were also more likely to be initiated on 5-ASA rather than biologic therapy (p<0.005). When current therapy was evaluated for well followed patients (i.e. treated prior to 2020 and seen in the 2021-2023 period for follow up therapy assessment). a switch from 5-ASA to biologics occurred regardless of race (34/37= 92%).
Conclusion: Racial disparities were seen in our AA compared to non-AA patients but over time the therapy differences were resolved as most patients were switched to biologic therapy.

Keywords

Crohn’s Disease, racial disparity, socioeconomical assessment, endoscopy, surgery, biomarkers