Clinical Investigation|Articles in Press

A Focused Retrospective Study on Differences in IBD Characteristics between Black and White Patients in the South

Published:February 24, 2023DOI:


      Background and Aims

      Most facets of Inflammatory Bowel Disease (IBD) have not been thoroughly compared among minority populations, including Black patients. Our study was designed to characterize the demographics, phenotypes, outcomes, healthcare utilization, and treatment of IBD in a large cohort with 38% Black patients.


      Electronic health records of 3272 IBD patients seen in a tertiary academic medical network from 2012 to July 15th, 2019 were analyzed.


      Black patients with Crohn's disease were significantly more likely than White patients to suffer from perianal (p < 0.001), fistulizing (p < 0.001), and fibrostenotic phenotypes (p < 0.001). Black patients with IBD were significantly more likely to undergo IBD-related surgery (p = 0.042) and experience an IBD-related complication (p < 0.001). The proportion of patients with at least one colonoscopy, one visit to the gastroenterology clinic, one visit to the emergency department (ED), and one hospital admission were higher in Black patients (p < 0.001, p = 0.005, p < 0.001, and p < 0.001; respectively).


      Black IBD patients had more severe disease phenotypes and worse healthcare outcomes than White patients. Black patients also used healthcare facilities and IBD medications to an equal or greater extent, despite being of a lower average socioeconomic class than their White counterparts. Our study suggests that underlying factors that do not pertain to the utilization of healthcare resources may be responsible for these worse outcomes in Black patients.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of the Medical Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ng SC
        • Kaplan GG
        • Tang W
        • et al.
        Population density and risk of inflammatory bowel disease: a prospective population-based study in 13 countries or regions in Asia-Pacific.
        Am J Gastroenterol. 2019; 114: 107-115
        • Kotze PG
        • Underwood F
        • Damiao AOMC
        • et al.
        Progression of inflammatory bowel diseases throughout Latin America and the Caribbean: a systematic review.
        Clin Gastroenterol Hepatol. 2020; 18: 304-312
        • Kaplan GG.
        The global burden of IBD: from 2015 to 2025.
        Nat Rev Gastroenterol Hepatol. 2015; 12: 720-727
        • Afzali A
        • Cross RK.
        Racial and ethnic minorities with inflammatory bowel disease in the United States: a systematic review of disease characteristics and differences.
        Inflamm Bowel Dis. 2016; 22: 2023-2040
        • Aniwan S
        • Harmsen WS
        • Tremaine WJ
        • et al.
        Incidence of inflammatory bowel disease by race and ethnicity in a population-based inception cohort from 1970 through 2010.
        Therap Adv Gastroenterol. 2019; 121756284819827692
        • Xu F
        • Carlson SA
        • Liu Y
        • et al.
        Prevalence of inflammatory bowel disease among Medicare fee-for-service beneficiaries - United States, 2001-2018.
        MMWR Morb Mortal Wkly Rep. 2021; 70: 698-701
        • Reddy SI
        • Burakoff R.
        Inflammatory bowel disease in African Americans.
        Inflamm Bowel Dis. 2003; 9: 380-385
        • Shivashankar R
        • Tremaine WJ
        • Harmsen WS
        • et al.
        Incidence and prevalence of Crohn's disease and ulcerative colitis in Olmsted County, Minnesota from 1970 Through 2010.
        Clin Gastroenterol Hepatol. 2017; 15: 857-863
        • Liu JJ
        • Abraham BP
        • Adamson P
        • et al.
        The current state of care for Black and Hispanic inflammatory bowel disease patients [published online ahead of print, 2022 Jul 11].
        Inflamm Bowel Dis. 2022;
        • MA Ma
        • Gutiérrez DE
        • Frausto JM
        • et al.
        Minority representation in clinical trials in the United States: trends over the past 25 years.
        Mayo Clin Proc. 2021; 96: 264-266
        • Barberio B
        • Gracie DJ
        • Black CJ
        • et al.
        Efficacy of biological therapies and small molecules in induction and maintenance of remission in luminal Crohn's disease: systematic review and network meta-analysis [published online ahead of print, 2022 Jul 30].
        Gut. 2022;
        • Alli-Akintade L
        • Pruthvi P
        • Hadi N
        • et al.
        Race and fistulizing perianal Crohn's disease.
        J Clin Gastroenterol. 2015; 49: e21-e23
        • Present DH
        • Rutgeerts P
        • Targan S
        • et al.
        Infliximab for the treatment of fistulas in patients with Crohn's disease.
        N Engl J Med. 1999; 340: 1398-1405
        • Sands BE
        • Anderson FH
        • Bernstein CN
        • et al.
        Infliximab maintenance therapy for fistulizing Crohn's disease.
        N Engl J Med. 2004; 350: 876-885
        • Nguyen GC
        • LaVeist TA
        • Harris ML
        • et al.
        Racial disparities in utilization of specialist care and medications in inflammatory bowel disease.
        Am J Gastroenterol. 2010; 105: 2202-2208
        • Flasar MH
        • Johnson T
        • Roghmann M-C
        • et al.
        Disparities in the use of immunomodulators and biologics for the treatment of inflammatory bowel disease: a retrospective cohort study.
        Inflamm Bowel Dis. 2008; 14: 13-19
      1. United States Census Bureau. 2019 American community survey demographic and housing 1-year estimates. Released September 17, 2020. Accessed January 5, 2021.

      2. “Hospitals and Clinics.” Accessed January 1, 2022.

      3. United States Census Bureau. 2013-2018 American community survey selected economic characteristics 5-year estimates data profiles. Released December 19, 2019. Accessed July 6, 2020.

        • Jackson 3rd, JF
        • Dhere T
        • Repaka A
        • et al.
        Crohn's disease in an African-American population.
        Am J Med Sci. 2008; 336: 389-392
        • Shi HY
        • Levy AN
        • Trivedi HD
        • et al.
        Ethnicity influences phenotype and outcomes in inflammatory bowel disease: a systematic review and meta-analysis of population-based studies.
        Clin Gastroenterol Hepatol. 2018; 16 (e11): 190-197
        • Nguyen GC
        • Torres EA
        • Regueiro M
        • et al.
        Inflammatory bowel disease characteristics among African Americans, Hispanics, and non-Hispanic Whites: characterization of a large North American cohort.
        Am J Gastroenterol. 2006; 101: 1012-1023
        • Barnes EL
        • Kochar B
        • Long MD
        • et al.
        Lack of difference in treatment patterns and clinical outcomes between black and white patients with inflammatory bowel disease.
        Inflamm Bowel Dis. 2018; 24: 2634-2640
        • Barnes EL
        • Loftus EV
        • Kappelman MD.
        Effects of Race and Ethnicity on Diagnosis and Management of Inflammatory Bowel Diseases.
        Gastroenterology. 2021; 160: 677-689
        • Montgomery Jr, SR
        • PD Butler
        • Wirtalla CJ
        • et al.
        Racial disparities in surgical outcomes of patients with Inflammatory Bowel Disease.
        Am J Surg. 2018 Jun; 215: 1046-1050
        • Dos Santos Marques IC
        • Theiss LM
        • Wood LN
        • et al.
        Racial disparities exist in surgical outcomes for patients with inflammatory bowel disease.
        Am J Surg. 2021 Apr; 221: 668-674
        • Sewell JL
        • Velayos FS
        Systematic review: the role of race and socioeconomic factors on IBD healthcare delivery and effectiveness.
        Inflamm Bowel Dis. 2013 Mar; 19: 627-643
        • Eidelwein AP
        • Thompson R
        • Fiorino K
        • et al.
        Disease presentation and clinical course in black and white children with inflammatory bowel disease.
        J Pediatr Gastroenterol Nutr. 2007; 44: 555-560
        • D'Haens G
        Top-down therapy for IBD: rationale and requisite evidence.
        Nat Rev Gastroenterol Hepatol. 2010; 7: 86-92
        • Nguyen GC
        • LaVeist TA
        • Harris ML
        • et al.
        Patient trust-in-physician and race are predictors of adherence to medical management in inflammatory bowel disease.
        Inflamm Bowel Dis. 2009; 15: 1233-1239
        • Nahon S
        • Lahmek P
        • Saas C
        • et al.
        Socioeconomic and psychological factors associated with nonadherence to treatment in inflammatory bowel disease patients: results of the ISSEO survey.
        Inflamm Bowel Dis. 2011; 17: 1270-1276
        • Sewitch MJ
        • Abrahamowicz M
        • Barkun A
        • et al.
        Patient nonadherence to medication in inflammatory bowel disease.
        Am J Gastroenterol. 2003; 98: 1535-1544
        • Ediger JP
        • Walker JR
        • Graff L
        • et al.
        Predictors of medication adherence in inflammatory bowel disease.
        Am J Gastroenterol. 2007; 102: 1417-1426
        • Zakai NA
        • McClure LA
        • Prineas R
        • et al.
        Correlates of anemia in American blacks and whites: the REGARDS Renal Ancillary Study.
        Am J Epidemiol. 2009; 169: 355-364
        • Njoku K
        • Burstiner LS
        • Owings AH
        • et al.
        Clinical Manifestations of Crohn's Disease in African Americans in a Rural versus Urban Setting [Abstract].
        Am J Gastroenterol. 2021; 116: S421-S422
      4. Analytics, University of Mississippi Medical Center, Center for Informatics and Analytics. Patient Cohort Explorer (PCE). Released May 6, 2020. Accessed September 5.