title: Phenotypic manifestations of inflammatory bowel disease differ between Hispanics and non-Hispanic whites: results of a large cohort study.
abstract: OBJECTIVE
  Hispanics are the fastest growing minority in the United States, yet few studies have examined the phenotypes of inflammatory bowel disease (IBD) in this population. No studies compare IBD presentation between foreign and US-born Hispanics. Our aim was to compare phenotypic characteristics of IBD between Hispanics and non-Hispanic Whites (NHWs), as well as between US-born and foreign-born Hispanics.
  
  
  METHODS
  We retrospectively identified cohorts of adult IBD patients from 1998 to 2009 and compared ethnic variation in phenotype, including disease type (Crohn's disease or ulcerative colitis (UC)), extra-intestinal manifestations (EIMs), Montreal classification, surgeries, hospitalizations, and medication prescription.
  
  
  RESULTS
  A total of 325 patients were included; 208 were Hispanics. Foreign-born Hispanics, accounting for 68% of the total, were diagnosed at an older age than US-born Hispanics and NHWs (45 vs. 25 and 27, respectively, P<0.05). Foreign-born Hispanics manifested more UC than US-born Hispanics or NHWs (59.9% vs. 41% and 28.2%, respectively, P<0.05). No difference was noted in the prevalence of EIMs between Hispanics and NHWs. More upper gastrointestinal tract Crohn's was observed in NHWs (12.5% vs. 3.9%, P<0.05). The incidence density rate of IBD-related surgeries in NHWs was higher than in Hispanics (22.9 vs. 7.3 surgeries/100 person-years, P<0.01, hazard ratio: 0.3, 95% confidence interval: 0.14-0.5). Hispanic patients had fewer prescriptions for biologics and immunomodulators than NHWs (22.2% vs. 55.6%, P<0.01 and 35.7% vs. 53.8%, P<0.01, respectively).
  
  
  CONCLUSIONS
  This study demonstrates differences in IBD presentation among NHW, US-born Hispanic, and foreign-born Hispanic groups. Further investigation to identify environmental and genetic differences between ethnic groups affected by IBD is warranted.
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, Florida 33101, USA.
authors.forename: Oriana M
authors.initials: OM
authors.lastname: Damas
authors.forename: Darius A
authors.initials: DA
authors.lastname: Jahann
authors.forename: Robert
authors.initials: R
authors.lastname: Reznik
authors.forename: Jacob L
authors.initials: JL
authors.lastname: McCauley
authors.forename: Leonardo
authors.initials: L
authors.lastname: Tamariz
authors.forename: Amar R
authors.initials: AR
authors.lastname: Deshpande
authors.forename: Maria T
authors.initials: MT
authors.lastname: Abreu
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Sussman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000208:ethnology; D003424:Crohn Disease / Q000175:diagnosis / Q000208:ethnology; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005431:Florida / Q000453:epidemiology; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology* / Q000601:surgery; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010641:Phenotype; D012189:Retrospective Studies; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D000893:Anti-Inflammatory Agents; D001688:Biological Products; D005765:Gastrointestinal Agents; D007155:Immunologic Factors