title: Racial Differences in the Clinical Profile, Causes, and Outcome of Chronic Pancreatitis.
abstract: OBJECTIVE
  Racial differences in susceptibility and progression of pancreatitis have been reported in epidemiologic studies using administrative or retrospective data. There has been little study, however, on the clinical profile, causes, and outcome of chronic pancreatitis (CP) in black patients.
  
  
  METHODS
  We analyzed data on black patients with CP prospectively enrolled in the multicenter North American Pancreatitis Studies from 26 US centers during the years 2000-2014. CP was defined by definitive evidence on imaging studies or histology. Information on demographics, etiology, risk factors, disease phenotype, treatment, and perceived effectiveness was obtained from responses to detailed questionnaires completed by both patients and physicians.
  
  
  RESULTS
  Of the 1,159 patients enrolled, 248 (21%) were black. When compared with whites, blacks were significantly more likely to be male (60.9 vs. 53%), ever (88.2 vs. 71.8%), or current smokers (64.2 vs. 45.9%), or have a physician-defined alcohol etiology (77 vs. 41.9%). There was no overall difference in the duration of CP although for alcoholic CP, blacks had a longer duration of disease (8.6 vs. 6.97 years; P=0.02). Blacks were also significantly more likely to have advanced changes on pancreatic morphology (calcifications (63.3 vs. 55.2%), atrophy (43.2 vs. 34.6%), pancreatic ductal stricture or dilatation (72.6 vs. 65.5%) or common bile duct stricture (18.6 vs. 8.2%)) and function (endocrine insufficiency 39.9 vs. 30.2%). Moreover, the prevalence of any (94.7 vs. 83%), constant (62.6 vs. 51%), and severe (78.4 vs. 65.8%) pain and disability (35.1 vs. 21.4%) were significantly higher in blacks. Observed differences were in part related to variances in etiology and duration of disease. No differences in medical or endoscopic treatments were seen between races although prior cholecystectomy (31.1 vs. 19%) was more common in white patients.
  
  
  CONCLUSIONS
  Differences were observed between blacks and whites in the underlying cause, morphologic expression, and pain characteristics of CP, which in part are explained by the underlying risk factor(s) with alcohol and tobacco being much more frequent in black patients as well as disease duration.
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: C Mel
authors.initials: CM
authors.lastname: Wilcox
authors.affiliation: Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
authors.forename: Bimaljit S
authors.initials: BS
authors.lastname: Sandhu
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Vikesh
authors.initials: V
authors.lastname: Singh
authors.affiliation: University of Chicago, Chicago, Illinois, USA.
authors.forename: Andres
authors.initials: A
authors.lastname: Gelrud
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Judah N
authors.initials: JN
authors.lastname: Abberbock
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Sherman
authors.affiliation: Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Cote
authors.affiliation: Saint Louis University School of Medicine, St Louis, Missouri, USA.
authors.forename: Samer
authors.initials: S
authors.lastname: Al-Kaade
authors.affiliation: University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Anderson
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Gardner
authors.affiliation: Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Michele D
authors.initials: MD
authors.lastname: Lewis
authors.affiliation: University of Florida College of Medicine, Gainesville, Florida, USA.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Forsmark
authors.affiliation: University of Wisconsin School of Medicine, Milwaukee, Wisconsin, USA.
authors.forename: Nalini M
authors.initials: NM
authors.lastname: Guda
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Romagnuolo
authors.affiliation: Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: John
authors.initials: J
authors.lastname: Baillie
authors.affiliation: North Mississippi Medical Center, Tupelo, Mississippi, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Amann
authors.affiliation: Yale University, New Haven, Connecticut, USA.
authors.forename: Thiruvengadam
authors.initials: T
authors.lastname: Muniraj
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Gong
authors.initials: G
authors.lastname: Tang
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Darwin L
authors.initials: DL
authors.lastname: Conwell
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Banks
authors.affiliation: Evanston Northwestern Healthcare, Chicago, Illinois, USA.
authors.forename: Randall E
authors.initials: RE
authors.lastname: Brand
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Slivka
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: David
authors.initials: D
authors.lastname: Whitcomb
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Yadav
mesh_terms: D015746:Abdominal Pain / Q000208:ethnology*; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001284:Atrophy; D002114:Calcinosis / Q000208:ethnology; D003137:Common Bile Duct Diseases / Q000208:ethnology*; D003251:Constriction, Pathologic / Q000208:ethnology; D010188:Exocrine Pancreatic Insufficiency / Q000208:ethnology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010179:Pancreas / Q000473:pathology; D010182:Pancreatic Diseases / Q000208:ethnology; D010183:Pancreatic Ducts / Q000473:pathology; D019512:Pancreatitis, Alcoholic / Q000208:ethnology* / Q000473:pathology; D050500:Pancreatitis, Chronic / Q000208:ethnology* / Q000209:etiology / Q000473:pathology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000208:ethnology*; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult