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Observational Study
. 2019 Oct 28;25(40):6145-6157.
doi: 10.3748/wjg.v25.i40.6145.

Ethnic differences in inflammatory bowel disease: Results from the United Kingdom inception cohort epidemiology study

Ravi Misra  1 , Jimmy Limdi  2 , Rachel Cooney  3 , Samia Sakuma  4 , Matthew Brookes  5 , Edward Fogden  6 , Sanjeev Pattni  7 , Naveen Sharma  8 , Tariq Iqbal  3 , Pia Munkholm  9 , Johan Burisch  9 , Naila Arebi  4
Affiliations
Observational Study

Ethnic differences in inflammatory bowel disease: Results from the United Kingdom inception cohort epidemiology study

Ravi Misra et al. World J Gastroenterol. .

Abstract

Background: The current epidemiology of inflammatory bowel disease (IBD) in the multi-ethnic United Kingdom is unknown. The last incidence study in the United Kingdom was carried out over 20 years ago.

Aim: To describe the incidence and phenotype of IBD and distribution within ethnic groups.

Methods: Adult patients (> 16 years) with newly diagnosed IBD (fulfilling Copenhagen diagnostic criteria) were prospectively recruited over one year in 5 urban catchment areas with high South Asian population. Patient demographics, ethnic codes, disease phenotype (Montreal classification), disease activity and treatment within 3 months of diagnosis were recorded onto the Epicom database.

Results: Across a population of 2271406 adults, 339 adult patients were diagnosed with IBD over one year: 218 with ulcerative colitis (UC, 64.3%), 115 with Crohn's disease (CD, 33.9%) and 6 with IBD unclassified (1.8%). The crude incidence of IBD, UC and CD was 17.0/100000, 11.3/100000 and 5.3/100000 respectively. The age adjusted incidence of IBD and UC were significantly higher in the Indian group (25.2/100000 and 20.5/100000) compared to White European (14.9/100000, P = 0.009 and 8.2/100000, P < 0.001) and Pakistani groups (14.9/100000, P = 0.001 and 11.2/100000, P = 0.007). The Indian group were significantly more likely to have extensive disease than White Europeans (52.7% vs 41.7%, P = 0.031). There was no significant difference in time to diagnosis, disease activity and treatment.

Conclusion: This is the only prospective study to report the incidence of IBD in an ethnically diverse United Kingdom population. The Indian ethnic group showed the highest age-adjusted incidence of UC (20.5/100000). Further studies on dietary, microbial and metabolic factors that might explain these findings in UC are underway.

Keywords: Epidemiology; Ethnicity; Incidence; Inflammatory bowel disease; Phenotype.

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Conflict of interest statement

Conflict-of-interest statement: There are no conflicts of interest.

Figures

Figure 1
Figure 1
Ethnic differences in age-adjusted incidence rates with standard error bars for inflammatory bowel disease in England. IBD: Inflammatory bowel disease; CD: Crohn’s disease; UC: Ulcerative colitis; IBDU: Inflammatory bowel disease unclassified.
Figure 2
Figure 2
Ulcerative colitis incidence by ethnicity over adult age spectrum.
Figure 3
Figure 3
Extent of ulcerative colitis at diagnosis across ethnic groups.
Figure 4
Figure 4
Disease location and behaviour of Crohn’s disease by ethnic group.
See this image and copyright information in PMC

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