Alsabbagh Alchirazi Khaled, Hamid Osama, Qapaja Thabet, Aldiabat Mohammad, Azzouz Nour, Alkhayyat Motasem, Regueiro Miguel
Department of Gastroenterology, Aurora Health Care, Milwaukee, WI, USA.
Department of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Crohns Colitis 360. 2025 Mar 16;7(2):otaf021. doi: 10.1093/crocol/otaf021. eCollection 2025 Apr.
Although traditionally associated with White European ancestry, inflammatory bowel disease (IBD) has increased among different races and ethnicities. Large studies conducted in the United States and Canada have identified more complex disease phenotypes among Black patients. Our study aimed to investigate disparities in IBD treatments and outcomes between Black and White patients in the United States.
Using the TriNetX database, adult IBD patients were divided into 2 groups based on race: Black and White patients with IBD, Crohn's disease (CD), or ulcerative colitis (UC). Medical therapy and disease outcomes were evaluated in both groups with 1:1 propensity-score matching. Methodologic limitations include the potential for missing data, lack of information on socioeconomic strata, and patient-level medication coverage plans.
In comparison to White patients, Black patients with CD were less likely to receive advanced therapies; Adalimumab (adjusted odds ratio- aOR 0.89), Certolizumab (0.81), Vedolizumab (0.66), Ustekinumab (0.82), or Tofacitinib (0.58). Black patients with UC were less likely to receive advanced therapies; Adalimumab (0.83), Golimumab (0.62), Vedolizumab (0.69), Ustekinumab (0.73), or Tofacitinib (0.55). Black patients with IBD were at higher odds of utilizing corticosteroids (CD 1.18 and UC 1.20) and opioids (CD 1.26 and UC 1.09). Black patients with CD had higher rates of hospitalization (1.35) and perianal abscess (1.56), perianal fistula (1.28), and intestinal fistula (1.38). Black patients with UC had higher rates of hospitalization (1.29), Clostridioides difficile infection (1.11), and toxic megacolon (1.34).
There were racial disparities in IBD medical therapy and disease outcomes. Black IBD patients had lower treatment with advanced therapies, higher opioid and corticosteroid use, and higher IBD-related complications.
尽管炎症性肠病（IBD）传统上与欧洲白人血统相关，但在不同种族和民族中其发病率都有所上升。在美国和加拿大进行的大型研究发现，黑人患者的疾病表型更为复杂。我们的研究旨在调查美国黑人和白人IBD患者在治疗和预后方面的差异。
利用TriNetX数据库，将成年IBD患者按种族分为两组：患有IBD、克罗恩病（CD）或溃疡性结肠炎（UC）的黑人和白人患者。采用1:1倾向评分匹配对两组患者的药物治疗和疾病预后进行评估。方法学上的局限性包括可能存在数据缺失、缺乏社会经济阶层信息以及患者层面的药物覆盖计划。
与白人患者相比，患有CD的黑人患者接受先进疗法的可能性较小；阿达木单抗（调整后的优势比—aOR 0.89）、赛妥珠单抗（0.81）、维多珠单抗（0.66）、乌司奴单抗（0.82）或托法替布（0.58）。患有UC的黑人患者接受先进疗法的可能性较小；阿达木单抗（0.83）、戈利木单抗（0.62）、维多珠单抗（0.69）、乌司奴单抗（0.73）或托法替布（0.55）。患有IBD的黑人患者使用皮质类固醇（CD为1.18，UC为1.20）和阿片类药物（CD为1.26，UC为1.09）的几率更高。患有CD的黑人患者住院率（1.35）以及肛周脓肿（1.56）、肛周瘘管（1.28）和肠瘘（1.38）的发生率更高。患有UC的黑人患者住院率（1.29）、艰难梭菌感染（1.11）和中毒性巨结肠（1.34）的发生率更高。
IBD的药物治疗和疾病预后存在种族差异。患有IBD的黑人患者接受先进疗法的治疗率较低，阿片类药物和皮质类固醇的使用较多，且与IBD相关的并发症较多。
