Common belief based on clinical experience suggests that Crohn's disease is more severe among black patients.
Little data exists on the effect of race on Crohn's disease.
Dr Peter Deveaux and colleagues compared multiple variables among black patients with Crohn's disease requiring surgery.
The variables in this patient group were compared to those of white patients presenting to a university colorectal surgery unit during a 5-year period.
|65% of black females presented with inflammatory symptoms compared with 28% of white females|
|Diseases of the Colon & Rectum|
The team reported that a total of 345 patients required surgery for Crohn's disease between 1998 and 2003.
The research team abstracted data from patient charts and prospectively maintained a database.
The abstracted data from the patient charts included age at diagnosis, age at first Crohn's disease surgery and presenting symptoms.
Other data abstracted by the team included incidence, number and location of fistulas at presentation, and number of Crohn's disease operations.
The researchers also obtained data on family history of inflammatory bowel disease, and data regarding medical insurance coverage.
The team reported that complete data were evaluable on 178 patients.
Patient variables were analyzed using the chi-squared, Fisher exact, and Student t-tests.
The researchers noted that the mean age at diagnosis was 28 years for white males and 20 years for black males.
The mean age of diagnosis amongst white females was 30 years, and 28 years for black females.
The researchers found that 37% of white females presented with obstructive symptoms versus 12% of black females.
The research team observed that 65% of black females presented with inflammatory symptoms compared with 28% of white females.
Of females presenting with fistulas, 15% of black patients had a rectovaginal fistula compared with 5% of white patients.
The team observed that 17% of black males and 21% of white males had intra-abdominal fistulas.
However, the team note that none of these differences were statistically significant.
The incidence of fistulas at presentation, mean number of fistulas, total number of operations, and family history of inflammatory bowel disease also did not differ.
Dr Deveaux's team concludes, “Contrary to expectations, Crohn's disease does not seem to be more severe among black patients, who had an earlier age of diagnosis, although this was not statistically significant.”
“Overall, there was no difference in disease presentation.”
“White females were more likely to present with obstructive symptoms compared with black females, who more often presented with inflammatory symptoms.”
“Among patients with fistulas, the incidence of rectovaginal fistulas was higher in black females compared with white females, and white males were somewhat more likely to have intra-abdominal fistulas than black males.”
“Although there was no demonstrated difference in incidence and mean number of fistulas at presentation, the number of operations for Crohn's disease, or family history of inflammatory bowel disease among blacks and whites, there are differences in presenting symptoms among these populations.”