Castaneda Garland, Liu Benny, Torres Sharon, Bhuket Taft, Wong Robert J
Department of Medicine, Alameda Health System - Highland Hospital, Oakland, CA, USA.
Division of Gastroenterology and Hepatology, Alameda Health System - Highland Hospital, 1411 East 31st Street, Highland Hospital - Highland, Care Pavilion 5th Floor, Endoscopy Unit, Oakland, CA, 94602, USA.
Dig Dis Sci. 2017 Oct;62(10):2876-2881. doi: 10.1007/s10620-017-4733-5. Epub 2017 Aug 30.
While ulcerative colitis (UC) is well studied in Caucasian populations, less data are available on UC patients of racial/ethnic minorities, including variations in disease severity at presentation.
To evaluate race/ethnicity-specific disparities in UC disease presentation among an ethnically diverse underserved population.
We performed a cross-sectional study of all consecutive UC adults among a large ethnically diverse safety-net hospital from July 2014 to May 2016 to compare race/ethnicity-specific disparities in severity of disease at presentation. Severity was evaluated using the clinician-based simple clinical colitis activity index (SCCAI) and the Mayo score at time of presentation. Multivariate ordered logistic regression models were used to evaluate associations with SCCAI and Mayo scores.
Among 98 UC patients (56.1% male, mean age 40.1 (SD 14.2), 32.0% were African-American, 26.7% Hispanic, 16.0% Asian, and 20.0% Caucasian. Mean Mayo score was 6.6 and mean SCCAI score was 6.5. When stratified by race/ethnicity, SCCAI scores were significantly higher in non-Caucasians compared to Caucasians (7.0 vs 4.6, p = 0.03) and in Asians compared to Caucasians (8.0 vs 4.6, p = 0.02). There was a trend toward higher mean SCCAI in Hispanics compared to Caucasians (6.9 vs 4.6, p = 0.07). Mayo scores at presentation demonstrated similar trends. On multivariate logistic regression, Asians (OR 5.26, 95% CI 1.24-22.42) and Hispanics (OR 3.74; 95% CI 1.02-13.66) had more severe disease at presentation than Caucasians based on SCCAI.
Among a diverse underserved cohort of UC patients, racial/ethnic minority patients with UC, specifically Asians and Hispanics, had more severe disease at presentation compared to Caucasians. The differences may reflect disparities in timely access to specialty care and treatment and deserves greater attention and research.
虽然溃疡性结肠炎（UC）在白种人群体中已有充分研究，但关于种族/族裔少数群体UC患者的数据较少，包括疾病初发时严重程度的差异。
评估在一个种族多样化的医疗服务不足人群中，UC疾病初发时种族/族裔特异性差异。
我们对2014年7月至2016年5月期间一家大型种族多样化安全网医院中所有连续性UC成年患者进行了横断面研究，以比较疾病初发时种族/族裔特异性严重程度差异。使用基于临床医生的简单临床结肠炎活动指数（SCCAI）和初发时的梅奥评分来评估严重程度。采用多变量有序逻辑回归模型评估与SCCAI和梅奥评分的关联。
98例UC患者中（56.1%为男性，平均年龄40.1岁（标准差14.2），32.0%为非裔美国人，26.7%为西班牙裔，16.0%为亚裔，20.0%为白种人。平均梅奥评分为6.6，平均SCCAI评分为6.5。按种族/族裔分层时，非白种人SCCAI评分显著高于白种人（7.0对4.6，p = 0.03），亚裔高于白种人（8.0对4.6，p = 0.02）。西班牙裔平均SCCAI有高于白种人的趋势（6.9对4.6，p = 0.07）。初发时的梅奥评分显示类似趋势。多变量逻辑回归分析显示，基于SCCAI，亚裔（比值比5.26，95%置信区间1.24 - 22.42）和西班牙裔（比值比3.74；95%置信区间1.02 - 13.66）初发时疾病比白种人更严重。
在一个多样化的医疗服务不足的UC患者队列中，UC种族/族裔少数群体患者，特别是亚裔和西班牙裔，初发时疾病比白种人更严重。这些差异可能反映了在及时获得专科护理和治疗方面的差距，值得更多关注和研究。
