Balarajah Sharmili, Martinez-Gili Laura, Alexander James Leslie, Mullish Benjamin Harvey, Perry Robert William, Li Jia V, Marchesi Julian Roberto, Parkes Miles, Orchard Timothy Robin, Hicks Lucy Charlotte, Williams Horace Richard Timothy
Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Department of Gastroenterology and Hepatology, Imperial College Healthcare NHS Trust, London, UK.
J Crohns Colitis. 2025 Jan 11;19(1). doi: 10.1093/ecco-jcc/jjae186.
Studies in the UK and North America have suggested a distinct disease profile in South Asians compared to that of White populations. Disparities in the medical and surgical management of IBD in minority ethnic groups (including Black Americans and Asians) in the US have been shown, while data from Europe, including the UK, have been lacking. This study sought to evaluate South Asian (SA) and White (WH) inflammatory bowel disease (IBD) phenotypes, and to explore treatment approach variations between these cohorts in the UK using the IBD BioResource database.
Differences between WH and SA IBD patients were analysed using demographic, phenotypic and outcome data. Drug utilisation patterns and surgical outcomes were assessed in propensity score-matched (PSM) cohorts with multivariable logistic regression, Cox regression and Kaplan-Meier analysis.
30,997 eligible patients were included. UC was the predominant disease subtype in SA (p<0.001). SA were younger at diagnosis (p<0.001), had a male preponderance (p<0.001), and were less likely to have a smoking history at diagnosis. The SA CD phenotype differed from WH, with less ileal (SA 30.3%, WH 38.4%, p=0.008) and stricturing (SA 16.9%, WH 25.6%, p<0.001) disease, but more perianal disease (SA 38.5%, WH 32.2%, p=0.009). More SA UC patients had extensive disease (SA 41.7%, WH 34.1%, p<0.001). In PSM cohorts, comparing treatments, there were no differences in 5-aminosalicylate, corticosteroid, thiopurine, anti-TNF or vedolizumab use. Survival analysis in matched cohorts showed no difference in time to surgery (CD) or colectomy (UC), and SA ethnicity was not associated with a difference in risk of surgery/colectomy.
Demographic and phenotypic differences exist between UK SA and WH IBD patients, highlighting distinct ethnicity-related variance, and the need for a research focus on under-represented populations. In comparing matched SA and WH patients, no disparity in medical and surgical IBD therapy in UK healthcare has been demonstrated: treatment is consistent regardless of ethnicity.
英国和北美的研究表明,与白种人群相比,南亚人群的疾病特征有所不同。美国少数族裔(包括非裔美国人和亚洲人)在炎症性肠病(IBD)的药物治疗和手术治疗方面存在差异,而包括英国在内的欧洲的数据一直缺乏。本研究旨在评估南亚(SA)和白种(WH)炎症性肠病(IBD)的表型,并利用IBD生物资源数据库探讨英国这些队列之间的治疗方法差异。
使用人口统计学、表型和结局数据对WH和SA IBD患者之间的差异进行分析。在倾向评分匹配(PSM)队列中,采用多变量逻辑回归、Cox回归和Kaplan-Meier分析评估药物使用模式和手术结局。
纳入30997例符合条件的患者。溃疡性结肠炎(UC)是SA中的主要疾病亚型(p<0.001)。SA患者诊断时年龄较小(p<0.001),男性居多(p<0.001),诊断时吸烟史的可能性较小。SA克罗恩病(CD)表型与WH不同,回肠疾病较少(SA为30.3%,WH为38.4%,p=0.008),狭窄性疾病较少(SA为16.9%,WH为25.6%,p<0.001),但肛周疾病较多(SA为38.5%,WH为32.2%,p=0.009)。更多SA UC患者患有广泛性疾病(SA为41.7%,WH为34.1%,p<0.001)。在PSM队列中,比较治疗情况,5-氨基水杨酸、皮质类固醇、硫唑嘌呤、抗TNF或维多珠单抗的使用没有差异。匹配队列中的生存分析显示,手术时间(CD)或结肠切除术(UC)没有差异,SA种族与手术/结肠切除术风险的差异无关。
英国SA和WH IBD患者在人口统计学和表型上存在差异,突出了与种族相关的独特差异,以及对代表性不足人群进行研究的必要性。在比较匹配的SA和WH患者时,未发现英国医疗保健中IBD药物治疗和手术治疗存在差异:无论种族如何,治疗都是一致的。