Rates of hospitalization among African American and Caucasian American patients with Crohn's disease seen at a tertiary care center

Caroline H Walker; Sumant S Arora; Lisandro D Colantonio; Donny D Kakati; Paul S Fitzmorris; Daniel I Chu; Talha A Malik

doi:10.1093/gastro/gow036

Rates of hospitalization among African American and Caucasian American patients with Crohn's disease seen at a tertiary care center

Gastroenterol Rep (Oxf). 2017 Nov;5(4):288-292. doi: 10.1093/gastro/gow036. Epub 2016 Dec 10.

Authors

Caroline H Walker¹, Sumant S Arora², Lisandro D Colantonio³, Donny D Kakati⁴, Paul S Fitzmorris⁵, Daniel I Chu⁶, Talha A Malik⁵

Affiliations

¹ Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA carolinewalker@uabmc.edu.
² Department of Internal Medicine, University of Alabama at Birmingham, Montgomery, AL, USA.
³ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
⁵ Department of Medicine-Gastroenterology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁶ Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.

Abstract

Background: There is equivocal evidence regarding differences in the clinical course and outcomes of Crohn's disease (CD) among African Americans compared with Caucasian Americans. We sought to analyze whether African Americans with CD are more likely to be hospitalized for CD-related complications when compared with Caucasian Americans with CD.

Methods: We conducted a retrospective cohort study including 909 African Americans and Caucasian Americans with CD who were seen at our tertiary care Inflammatory Bowel Disease (IBD) referral center between 2000 and 2013. We calculated the rate of hospitalization for CD-related complications among African Americans and Caucasian Americans separately. Zero-inflated Poisson regression models with robust variance estimates were used to estimate crude and multivariable adjusted rate ratios (RR) for CD-related hospitalizations. Multivariable adjusted models included adjustment for age, sex, duration of CD, smoking and CD therapy.

Results: The cumulative rate of CD-related hospital admissions was higher among African American patients compared with Caucasian American patients (395.6/1000 person-years in African Americans vs. 230.4/1000 person-years in Caucasian Americans). Unadjusted and multivariable adjusted rate ratios for CD-related hospitalization comparing African Americans and Caucasian Americans were 1.59 (95% confidence interval [95%CI]: 1.10-2.29; P=0.01) and 1.44 (95%CI: 1.02-2.03; P=0.04), respectively.

Conclusions: African Americans with CD followed at a tertiary IBD-referral center had a higher rate for CD-related hospitalizations compared with Caucasian Americans. Future studies should examine whether socioeconomic status and biologic markers of disease status could explain the higher risk observed among African Americans.

Keywords: African American; Caucasian American; Crohn’s disease; racial disparity.