S1245 Racial Disparities in Clinical Manifestation of Crohn’s Disease
Bibliographic record
Abstract
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)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".