Limited data exists on race differences in IBD. Our study aims to assess the effect of race on work productivity and impairment in African American (AA) and Caucasian (C) IBD patients, as well as evaluate race differences in the patients' perception of disease activity.Methods:
This is a prospective study in which surveys were administered to consecutive IBD patients obtaining colonoscopy at an academic endoscopy center from 10/15 to 4/16. Patients filled out validated surveys including: The Short Inflammatory Bowel Disease Questionnaire (SIBDQ), Hospital Anxiety and Depression Score (HADS), Work Productivity and Activity Impairment Questionnaire (WPAI), and HBI for Crohn's disease (CD) or Simple Colitis Activity Index (SCAI) for ulcerative colitis (UC). IBD specialists used the Simple Endoscopy Score for Crohn's Disease (SES-CD) and the endoscopic Mayo score for UC to evaluate colonic mucosa. Ostomy and J-pouch patients were excluded. Statistical analysis included Mann-Whitney U and Chi-square or Fisher's exact test.Results:
Fifty three patients were included in the study (38 Caucasian [18 CD and 20 UC] and 15 AA [7 CD and 8 UC]). Baseline socioeconomic factors were similar between Caucasian and AA patients, including, age, gender, employment, education, income, and insurance status. There were no differences in depression or anxiety (using HADS) between the 2 groups. Reported disease severity using HBI/SCAI, quality of life using SIBDQ and endoscopic scores were similar between AA and C. However, AA patients with IBD reported a significantly higher % of missed work due to health than C (7.1% versus 1.7%, P = 0.03) and greater % work impairment overall due to health (33.8% versus 14.8%, P = 0.046). Fifty percent of C reported disease severity consistent with their endoscopic scores, compared to only 13% of AA (P = 0.014). Significantly more AA IBD patients reported milder clinical disease severity (HBI < 5, SCAI < 5) while the same-day endoscopic score showed moderate-severe disease (CDSES ≥6, Mayo ≥2) (P = 0.0091).Conclusions:
AA patients with IBD reported more missed work and work impairment than Caucasian patients despite overall similar disease activity. AA were more likely to report disease severity that was milder than simultaneous endoscopic scores. This may lead to further silent progression of disease, causing later diagnosis of flares or IBD complications. Our data suggests that earlier and more frequent endoscopy may be warranted in AA patients with IBD.