Race and Ethnicity May Affect Outcomes in Pediatric Crohn Disease

Black children with Crohn disease (CD) have lower rates of 2-year steroid-free remission (SFR) compared with non-Hispanic White children with CD, according to a study published in the Journal of Pediatric Gastroenterology and Nutrition.

Researchers sought to determine the effects of race and ethnicity on pediatric CD diagnosis, pathology, treatment, and outcomes in a population with relatively high racial and ethnic diversity in the United States.

The retrospective review, conducted in November 2017, included electronic medical records (EMRs) of all pediatric patients within a hospital system in Texas. The participants were aged younger than 18 years and were diagnosed with CD from 2006 to 2015.

The patients were included only if symptom onset was attributable to CD, such as diarrhea, blood in stool, weight loss, or abdominal pain; was clearly documented in the record of the initial encounter; if they self-reported race and ethnicity; and if they had a minimum of 2 years of documented follow-up.

A total of 166 pediatric patients with CD were included (male, 54%; non-Hispanic White, 58%; Black, 18%; and Hispanic, 16%). The participants had a median age at diagnosis of 13.51 (IQR, 10.95-15.26) years and a median time to diagnosis of 3.32 (IQR, 1.25-7.03) months.

The primary outcomes were SFR and operation status 2 years after diagnosis.

Hispanic patients had a significantly older age at diagnosis (P =.0164) compared with non-Hispanic White patients and also were diagnosed early significantly more frequently (P <.01).

Black patients had increased C-reactive protein levels at diagnosis compared with non-Hispanic White patients (4.5 mg/dL [IQR, 2.35-6.65] vs 2.3 mg/dL [IQR, 0.61-4.26], respectively; P <.01). The erythrocyte sedimentation rate was significantly higher (P =.0069) and the hemoglobin level was significantly lower (P = .0067) in patients who were diagnosed early.

Black participants (33%, P =.0063) and Hispanic participants (35%, P =.0142) had lower rates of granuloma detection on diagnostic biopsies compared with non-Hispanic White patients (63%).

A total of 137 (83%) patients achieved SFR at 2 years postdiagnosis. Black patients had a lower rate of 2-year SFR compared with non-Hispanic White patients (70% vs 88%, respectively; P =.0457). Patients with a late diagnosis had a significantly higher rate of overall operation-free status at 2 years (98%) vs those with an early diagnosis (88%) (P =.0390). No difference was found in SFR at 2 years between patients with an early or delayed diagnosis.

A lower calprotectin measurement within 1 month of diagnosis was associated with SFR at 2 years (P =.0404).

No significant difference was observed in 2-year operation status or SFR regarding early mesalamine, methotrexate, and thiopurine use. Among the participants who achieved 2-year SFR, a higher percentage were treated with early biologics compared with those who did not achieve 2-year SFR (66% vs 41%, respectively, P = .0193). Among the participants who did not achieve 2-year SFR, a higher percentage were treated with early steroids vs those who did achieve 2-year SFR (76% vs 50%, respectively, P =.0138).

The researchers noted that patient recall and documentation in the EMR was used to determine disease onset, which may have presented a potential study limitation, but concluded that it was unlikely to influence research findings

“Our findings implicate potentially important ancestry and/or socially driven differences in the pathogenesis of CD, at least in pediatric patients, which warrant future studies,” the study authors commented.