Crohn's disease in an African-American population

African-Americans have been underrepresented in most large Crohn's disease (CD) trials. This study was undertaken to assess the course and character of CD in African-Americans in comparison with whites.

We retrospectively compared the course and character of CD in African-American and white patients at 3 Atlanta hospitals. Ninety-nine patients (55 African-American, 44 whites) were enrolled. Telephone interviews and chart reviews were used to identify disease location, presence of fistulae and perirectal disease, surgical history, and medication use. Patients with ulcerative colitis or indeterminant colitis, and all non-African-Americans or whites, were excluded.

The numbers of male and female patients were similar (50 and 49). Overall, men comprised 54% of white patients and 47% of African-American patients. There were no significant differences in the setting in which CD were diagnosed, number of flares per year, or duration of symptoms before diagnosis. White patients were more likely to seek care for their CD in a clinic setting, both their primary care physicians (1.31 versus 0.21 visits/yr, P < 0.001) and their gastroenterologists (3.2 versus 2.3 visits/yr, P = 0.03). Small bowel (SB) disease was present more frequently in white patients, 84% versus 65% (P = 0.03), and SB resection was more common in this group, 59% versus 16% (P < 0.01). Colonic disease was more common in African-American patients, 89% versus 63% (P = 0.002). Perirectal fistulae were more frequent in African-American patients, 58% versus 22% (P < 0.001) white patients were more likely to report complete compliance with medical therapy, 77% versus 49% (P = 0.004). African-American patients more frequently discontinued medical therapy because they "felt better" (27% versus 9%, P = 0.02). Medication usage, including immunosuppressants, was similar in both groups, except that white patients were more likely to receive multiple doses of infliximab (34% versus 11%, P = 0.005). Both groups felt equally informed about CD, but white patients felt that their disease was under good control a greater percentage of the time, 71% versus 58% (P = 0.04).

These data lend credence to the suggestion that the nature of CD may be different in African-Americans compared with whites. However, despite this apparent difference in disease manifestation, the contribution of socioeconomic factors, access to health care, and understanding of the disease likely play a role as well.