Racial and ethnic differences in age at diagnosis are independent of socioeconomic factors in a pediatric inflammatory bowel disease cohort
Authors: Kemp Keri , Nagaraj Pooja , Orihuela Catheryn , Lorenz Robin , Maynard Craig , Pollock Jennifer , Jester Traci 
Published: May 2023

Up to 25% of inflammatory bowel disease (IBD) patients are diagnosed before the age of 18 years, and the incidence and prevalence of pediatric-onset IBD are increasing worldwide. Pediatric IBD is aggressive and delayed diagnosis is associated with stunted growth, delayed puberty, and an increased risk of complications. Historically, IBD has been viewed as a disease that predominantly affects non-Hispanic Whites. However, the incidence of IBD among racial and ethnic minorities is increasing. These demographic changes have sparked a growing awareness of disparities in the diagnosis and management of IBD, yet few studies have examined racial and ethnic differences in pediatric IBD. We enrolled a diverse cohort of 114 pediatric IBD patients (age 11–18, 71% non-Hispanic White, 19% Black, 2% Hispanic, 7% multiracial or other racial/ethnic minorities) from Children’s of Alabama in Birmingham, AL USA. The goal of this retrospective study was to investigate potential racial and ethnic differences in age and IBD biomarkers at the time of pediatric IBD diagnosis. Healthcare records were obtained within the first 30 days of diagnosis for erythrocyte sedimentation rate (ESR), C-reactive protein, albumin, hematocrit, and hemoglobin. Participants self-reported race/ethnicity and parents self-reported income and education. Multivariate models were used to examine the association of biomarker values and age at the time of diagnosis with race/ethnicity, sex, IBD disease type, parental income, and parental education. Racial/ethnic minority children (including Black, Hispanic, Asian, and multi-racial) had a greater mean age at diagnosis (11.7 ± 0.4 vs. 14.4 ± 0.4 years) compared to non-Hispanic White children, and this association was robust when adjusting for covariates ( β=1.51, p<0.001). Moreover, racial/ethnic minority children were more likely to be diagnosed at >12 y of age compared to non-Hispanic White children (OR=13.3, 95% CI=1.9–57.0, p=0.003). Having a college-educated parent reduced the likelihood of being diagnosed at >12 y of age for racial and ethnic minority children (OR=0.1, 95% CI=0.03–2.7, p=0.049), while parental income had no mediating effect. In addition, racial/ethnic minority children were more likely to have elevated ESR at the time of their diagnosis compared to non-Hispanic White children (OR=5.76, 95% CI=1.19–55.95, p=0.024), though this association was not robust to covariate adjustment. In conclusion, minority race/ethnicity was linked to older age at diagnosis, and this association was independent of socioeconomic factors. However, parental attainment of a college education may attenuate the effect of minority race/ethnicity on age at diagnosis. This study highlights the critical need for more research examining how race/ethnicity intersect with other social determinants of health, including parental education and health literacy, to impact disparities in the diagnosis, management, and morbidity of pediatric IBD. This work was supported by a Crohn's and Colitis Foundation Translational Research Initiatives (Environmental Triggers) Award. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.