Crohn's disease in black children is worse in 6 ways

Created December 2017

Racial disparities in readmission, complications, and procedures in children with Crohn's disease.

Inflamm Bowel Dis. 2015 Apr;21(4):801-8. doi: 10.1097/MIB.0000000000000325.

Dotson JL1, Kappelman MD, Chisolm DJ, Crandall WV.

* People with gut problems are low on vitamin D* Intestinal absorption of vitamin D - a systematic review - Aug 2017* Crohn’s Disease risk increased 3 X if inadequate vitamin D level (another form is needed) – Oct 2017* Crohn's Disease relapse rate of 3 in 8 with 1,000 IU vs 0 in 12 with 10,000 IU of Vitamin D – RCT Feb 2017* Crohn's Disease patients normalizing their Vitamin D levels decreased risk of surgery by 44 percent – Aug 2013Overview Gut and vitamin D contains gut-friendly information{include}Increased health problems in blacks is similar to that of low vitamin D whites (John Singleton Stroke) 1. Overview Dark Skin and Vitamin D contains the following summary{include}---More to Consider in The Battle Against Crohn's Amazon $29, 2016Book has section on Crohn's and Vitamin D---1. of ways in results (below) were added by Vitamin D Life

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BACKGROUND:

Racial disparities in care and outcomes contribute to mortality and morbidity in children; however, the role in pediatric Crohn's disease is unclear. In this study, we compared cohorts of black and white children with Crohn's disease to determine the extent race is associated with differences in readmissions, complications, and procedures among hospitalizations in the United States.

METHODS:

Data were extracted from the Pediatric Health Information System (January 1, 2004-June 30, 2012) for patients with 21 years or younger hospitalized with a diagnosis of Crohn's disease. White and black cohorts were randomly selected in a 2:1 ratio by hospital. The primary outcome was time from index hospital discharge to readmission. The most frequent complications and procedures were evaluated by race.

RESULTS:

There were 4377 patients. Black children had a

  1. shorter time to first readmission and

  2. higher probability of readmission (P = 0.009) and a

  3. 16% increase in risk of readmission

    • compared with white children (P = 0.01). Black children had

  4. longer length of stay and

  5. higher frequency of overall and

  6. late (30-d to 12-mo postdischarge) readmissions (P < 0.001).

  7. During index hospitalization, more black children had perianal disease and anemia (P < 0.001).

    • During any hospitalization, black children had

  8. higher incidence of perianal disease,

  9. anemia, and

  10. vitamin D deficiency, [2.3% vs .9%] and

  11. greater number of perianal procedures,

  12. endoscopies, and

  13. blood product transfusion (P < 0.001).

CONCLUSIONS:

There are differences in hospital readmissions, complications, and procedures among hospitalized children related to race. It is unclear whether these differences are due to genetic differences, worse intrinsic disease, adherence, access to treatment, or treatment disparities.

Comment in

African Americans May Access the Emergency Department for Inflammatory Bowel Disease Care More Often than Whites.

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Tags: Darker Skin Gut Infant-Child