Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing, China; Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong.
Department of Medicine, Tufts Medical Center, Boston, Massachusetts.
Clin Gastroenterol Hepatol. 2018 Feb;16(2):190-197.e11. doi: 10.1016/j.cgh.2017.05.047. Epub 2017 Jun 8.
BACKGROUND & AIMS: Inflammatory bowel diseases (IBDs) (Crohn's disease [CD], ulcerative colitis) are global diseases. Similarities and differences in disease presentation and outcomes across different geographic regions and ethnic groups have not been compared previously.
We performed a systematic review and meta-analysis of population-based cohort studies examining the phenotype and outcome of IBD across ethnic groups categorized as Whites, Blacks, Hispanics, and Asians. Further stratification was performed by migration status (native or immigrant). Pooled proportions of disease location, behavior, medication, and surgery use were calculated by using a random-effects model and compared statistically.
Our final analysis included 198 unique studies reporting outcomes on 525,425 IBD patients (Caucasian, 65%; Asian, 30%; Hispanic, 2%; and Black, 1%). CD in Asians but not other ethnicities demonstrated a strong male predominance. Family history of IBD was infrequent in Asian patients. Both Black and Asian CD patients demonstrated perianal involvement more frequently. Surgery for both CD and UC was less common in Asians than Caucasians. Compared with native residents, a family history of IBD was reported more often among immigrant IBD patients, but no significant differences were noted in phenotype.
We demonstrate significant variation in the demographic distribution, familial predisposition, phenotype, and outcomes of IBD between Caucasians, Blacks, Hispanics, and Asians. There is need for further study to understand the biology behind this variation.
炎症性肠病（IBD）（克罗恩病[CD]，溃疡性结肠炎）是全球性疾病。以前尚未比较过不同地理区域和种族群体在疾病表现和结局方面的相似性和差异。
我们对研究不同种族群体（白种人、黑种人、西班牙裔和亚洲人）中 IBD 表型和结局的基于人群的队列研究进行了系统评价和荟萃分析。进一步按移民身份（本地或移民）进行分层。使用随机效应模型计算疾病位置、行为、药物和手术使用的汇总比例，并进行统计学比较。
我们的最终分析包括 198 项独特的研究，报告了 525425 例 IBD 患者的结局（白种人，65%；亚洲人，30%；西班牙裔，2%；黑种人，1%）。亚洲人的 CD 但不是其他种族表现出强烈的男性优势。亚洲患者的 IBD 家族史罕见。黑人和亚洲的 CD 患者都更频繁地出现肛周受累。亚洲人的 CD 和 UC 手术比白种人少。与本地居民相比，移民 IBD 患者更常报告 IBD 家族史，但在表型方面没有显著差异。
我们证明了白种人、黑种人、西班牙裔和亚洲人之间在 IBD 的人口统计学分布、家族易感性、表型和结局方面存在显著差异。需要进一步研究以了解这种差异背后的生物学机制。
