S1245 Racial Disparities in Clinical Manifestation of Crohn’s Disease
Notice bibliographique
Résumé
Introduction: African Americans (AA) have been underrepresented in clinical studies of Crohn’s Disease (CD). This study aims to evaluate and compare the clinical manifestations and disease progression of CD in AA and whites (CC). Methods: We conducted a single-center cross-sectional study of all patients with CD, both hospitalized and outpatient, treated from 2019 to 2024. Chart reviews were used to identify disease location, peri rectal disease, strictures, penetrating natures, endoscopy and surgical history, extra intestinal manifestation, demographics, treatment and medication use. Patients with ulcerative colitis or indeterminant colitis were excluded. Results: A total of 167 patients were identified, comprising 43% AA and 56% CC. Mean age of diagnosis was 43±14.56 for AA and 47±15.71 for CC. The average measured BMI was higher in AA (28.55±8.07) than CC (26.01±5.93) (P < 0.005; Table 1). Although there was no significant gender difference in the overall diagnosis of CD, a higher prevalence was observed among females in AA (F/M ratio: 43/27 in AA vs 50/45 in CC). CDs related surgeries occurred in 71% of AA and 56% of CC. Time from diagnosis to surgery was 17 years for AA and 15 years for CC with a wide range of standard deviation. No significance differences noted in extra intestinal manifestations, undergoing surgeries, treatment modalities, insurances and perianal disease. AA were more likely to have penetrating phenotype (B3) and less likely to have inflammatory (B1) and stricturing phenotypes (B2) as compared to Whites (P < 0.004; Table 1). Multivariate logistic regression analysis revealed that the odds of having a B3 phenotype compared to a B1 phenotype were approximately 3.08 times higher for AA compared to CC (CI: 1.33-7.13) after adjusting for age, sex and BMI. In a subgroup analysis of those with the B3 phenotype, AA were less likely to use steroids compared to CC (32% Vs 53%, P < 0.05). Conclusion: This study showed that AA were more likely to develop complicated CD over time compared to CC. Higher BMI was noted among AA, however not correlated with complicated CD. AA were diagnosed younger, had a female predominance, longer time from diagnosis to surgery and underwent more surgeries. These findings suggest that CD may manifest differently in AA, though socioeconomic status, healthcare access, and awareness of the disease process may also play a role. Table 1. - Clinical disease characteristics and medication history of the patients in Crohn’s disease patients African Americans (AA)(n= 70) whites (CC)(n= 95) P-Value Variables Age (mean, SD) 43.26±14.56 47.41±15.71 0.51 BMI 28.55±8.07 26.01±5.93 0.01 Time from diagnosis to surgery 17.06±9.03 15.96±9.82 0.71 Sex 0.36 Male, % 27 (38.5) 45 (47.3) Female, % 43 (61.4) 50 (52.6) Extraintestinal manifestation 0.46 Arthritis 21 (30) 31 (32.6) Pyoderma gangrenosum 3 (4.1) 2 (2.1) Psoriasis 1 (1.4) 1 (1) Primary sclerosing cholangitis 1 (1.3) 1 (1) Surgery 0.12 Yes 50 (71.4) 56 (59) No 20 (28.5) 39 (41) Treatment Biologics 54 (75) 80 (84.2) 0.13 Immunomodulators 13 (18) 19 (20) 0.75 Steroids 26 (36.1) 44 (46.3) 0.18 5-ASA 23 (31.9) 36 (37.8) 0.42 Antibiotics 1 (1.3) 2 (2.1) 0.43 Combination 22 (30.5) 39 (41) 0.16 Insurance 0.08 Private 27 (37.5) 45 (47.3) Medicare 17 (23.6) 12 (12.6) Medicaid 14 (19.4) 15 (15.7) Veteran 2 (2.7) 6 (6.3) No insurance 11 (15.2) 17 (17.8) Peri-anal fistula 21 (29.1) 17 (17.8) 0.95 Peri-anal abscess 7 (9.7) 10 (10.5) 0.22 Montreal Crohn disease Ileal (L1) 8 (11.3) 15 (15.7) Colonic (L2) 11 (15.7) 18 (18.9) 0.17 Ileocolonic (L3) 49 (70) 61 (64.2) Isolated Upper GI (L4) 3 (4.1) 1 (1) B1 (inflammatory) 12 (16.6) 30 (31.5) 0.004 B2 (stricturing) 12 (16.6) 24 (25.2) B3 (penetrating) 46 (63.8) 41 (43.1)
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».