Race and Fistulizing Perianal Crohn's Disease

Background: There is increasing recognition of Crohn's disease (CD) in non-white populations. However, reports of racial disparities in the phenotype of CD are still inconsistent. Aim: The aim of this study was to test the hypothesis that African American (AA) patients have higher incidence of severe fistulizing perianal Crohn's disease (FPD) compared with white patients. Methods: Cross-sectional analysis of 333 adult CD patients treated at The Mount Sinai Hospital with infliximab between May 2011 and December 2011 was conducted. Self-reported race/ethnicity was recorded and proportions of each group with FPD were compared across the population. Results: Among all 333 evaluable CD patients on infliximab, 73.6% were white, 11.4% AA, 13.2% Hispanic, and 1.8% Asian. Of these 333 patients, 88 had FPD: only 48 of these (54.5%) were white, whereas fully 18 (20.5%) were AA, 20 (22.7%) were Hispanic, and 2 (2.3%) were Asian. Thus, patients receiving infliximab for FPD were significantly more likely to be AA or Hispanic than white (AA vs. whites: risk ratio = 2.63; 95% confidence interval, 1.74-3.96; P = < 0.0001; Hispanics vs. whites: risk ratio = 2.32; 95% confidence interval, 1.54-3.50; P = 0.0001). There was no statistically significant difference between AA and Hispanics. Conclusion: CD patients at our medical center with FPD requiring infliximab therapy were significantly more likely to be AA or Hispanic.