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. 2025 Jan 11;19(1):jjae186.
doi: 10.1093/ecco-jcc/jjae186.

Diverse Phenotypes, Consistent Treatment: A Study of 30 997 South Asian and White Inflammatory Bowel Disease Patients Using the UK Inflammatory Bowel Disease BioResource

Sharmili Balarajah  1   2 , Laura Martinez-Gili  1 , James Leslie Alexander  1   2   3 , Benjamin Harvey Mullish  1   2 , Robert William Perry  1   2 , Jia V Li  1 , Julian Roberto Marchesi  1 , Miles Parkes  4   5 , Timothy Robin Orchard  1   2 , Lucy Charlotte Hicks  1   2 , Horace Richard Timothy Williams  1   2
Affiliations

Diverse Phenotypes, Consistent Treatment: A Study of 30 997 South Asian and White Inflammatory Bowel Disease Patients Using the UK Inflammatory Bowel Disease BioResource

Sharmili Balarajah et al. J Crohns Colitis. .

Abstract

Background: Studies in the UK and North America have suggested a distinct disease profile in South Asians compared to that of White populations. Disparities in the medical and surgical management of IBD in minority ethnic groups (including Black Americans and Asians) in the US have been shown, while data from Europe, including the UK, have been lacking. This study sought to evaluate South Asian (SA) and White (WH) inflammatory bowel disease (IBD) phenotypes, and to explore treatment approach variations between these cohorts in the UK using the IBD BioResource database.

Design: Differences between WH and SA IBD patients were analysed using demographic, phenotypic and outcome data. Drug utilisation patterns and surgical outcomes were assessed in propensity score-matched (PSM) cohorts with multivariable logistic regression, Cox regression and Kaplan-Meier analysis.

Results: 30,997 eligible patients were included. UC was the predominant disease subtype in SA (p<0.001). SA were younger at diagnosis (p<0.001), had a male preponderance (p<0.001), and were less likely to have a smoking history at diagnosis. The SA CD phenotype differed from WH, with less ileal (SA 30.3%, WH 38.4%, p=0.008) and stricturing (SA 16.9%, WH 25.6%, p<0.001) disease, but more perianal disease (SA 38.5%, WH 32.2%, p=0.009). More SA UC patients had extensive disease (SA 41.7%, WH 34.1%, p<0.001). In PSM cohorts, comparing treatments, there were no differences in 5-aminosalicylate, corticosteroid, thiopurine, anti-TNF or vedolizumab use. Survival analysis in matched cohorts showed no difference in time to surgery (CD) or colectomy (UC), and SA ethnicity was not associated with a difference in risk of surgery/colectomy.

Conclusion: Demographic and phenotypic differences exist between UK SA and WH IBD patients, highlighting distinct ethnicity-related variance, and the need for a research focus on under-represented populations. In comparing matched SA and WH patients, no disparity in medical and surgical IBD therapy in UK healthcare has been demonstrated: treatment is consistent regardless of ethnicity.

Keywords: Crohn’s disease; IBD BioResource; South Asian; ethnicity; phenotype; treatment; ulcerative colitis.

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Conflict of interest statement

S.B. has received financial support to attend educational meetings from Falk and Ferring. J.L.A. has received financial support to attend conferences from Celltrion and Takeda and received speaker fees from AbbVie and Janssen. B.H.M. has received consultancy fees from Finch Therapeutics Groups (MA, USA). RP has received financial support to attend conferences from Ferring. J.R.M. has received fees for consultation from Cultech Ltd. and EnteroBiotix Ltd. M.P. has received personal fees from Janssen and Takeda (outside the submitted work), as well as grants from AstraZeneca, Galapagos, Gilead, and Pfizer (outside the submitted work). H.R.T.W. has been an advisory board member for Pfizer. All other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study flow chart (created in BioRender.com).
Figure 2
Figure 2
Hazard ratios in propensity-score matched groups: Risk of resection in CD (A), Risk of colectomy in UC (B).
Figure 3
Figure 3
Kaplan-Meier survival analysis in propensity-score matched cohorts: Time to surgery in CD (A), Time to colectomy in UC (B).
See this image and copyright information in PMC

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