For IBD in Kids, Ethnicity and Location Matter

Considerable variation exists in the prevalence of pediatric inflammatory bowel disease (pIBD) according to ethnicity, location, and disease subtype, a retrospective cohort study found.

For instance, pIBD’s prevalence among non-Hispanic whites was greater in the North than in the South (78.5% vs 72.2%, P=0.0002), while the prevalence among Hispanics was greater in the South (11.4% vs 5.3%, P<0.0001), reported Ernesto Robalino Gonzaga, MD, of the University of Central Florida in Orlando at the virtual 2020 Advances in Inflammatory Bowel Disease meeting.

IBD was previously thought to affect primarily the non-Hispanic white population, but research has now shown that its prevalence varies considerably among different ethnic groups, and that its incidence appears to be rising, particularly among nonwhites. For example, in one study that analyzed data from the Rochester Epidemiologic Project, the annual incidence rate for IBD among whites was 21.6 per 100,000 person-years compared with 13 per 100,000 for nonwhites, but the incidence rate for whites and nonwhites increased by 39% and 134%, respectively, from 1970 to 2010.

The incidence also appears to be increasing worldwide, and in Europe, an East-West gradient has been observed, with a steep increase in Eastern Europe.

To examine the current pattern of prevalence in the United States, the researchers examined electronic health records from 2000 to 2018 for children ages 18 years or younger from a national children’s hospital that participates in the PEDSnet research network.

They extracted information on patient demographics, encounters with healthcare providers, as well as diagnoses and procedures. Outcomes of interest were geographic location (North vs South), sex, race/ethnicity, age at diagnosis, tobacco use, socioeconomic status, and need for surgery.

The analysis included 2,409 pIBD patients, with 75.5% being non-Hispanic white, 13.3% being non-Hispanic Black, 8.2% being Hispanic, 2.5% being Asian, and 0.5% being “other.”

For Crohn’s disease, there was no difference in prevalence between North and South, at 68.8% and 69%, respectively (P=0.92), but ulcerative colitis was more prevalent in the South (27.3% vs 23.2%, P=0.02).

No differences in male predominance was observed between North and South (55.3% vs 54.3%, P=0.62). There also were no differences in pIBD prevalence between North and South for non-Hispanic Blacks, Asians, or “other” groups.

Among Hispanics, the prevalence of Crohn’s disease was greater in the South (10.3% vs 5%, P<0.0001), as was the prevalence of ulcerative colitis (14% vs 6.2%, P=0.001).

For non-Hispanic whites, the prevalence of Crohn’s disease was higher in the North (78.3% vs 72.2%, P<0.05), as was the prevalence of ulcerative colitis (80.1% vs 72%, P<0.05).

These observations suggest that a North-South gradient exists for pIBD, and further studies will be needed to further explore the racial and ethnic differences and other factors that might contribute to this, Gonzaga said.