Epidemiology of inflammatory bowel disease in racial and ethnic migrant groups

doi:10.3748/wjg.v24.i3.424

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World Journal of Gastroenterology

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World J Gastroenterol. Jan 21, 2018; 24(3): 424-437
Published online Jan 21, 2018. doi: 10.3748/wjg.v24.i3.424

Table 1 Incidence of Crohn’s disease and ulcerative colitis

Study characteristics and demographics						Study quality characteristics
Study	Country (region)	Study period	Number of cases	Incidence rate/100000		Diagnosis based on recognised criteria	Ethnicity reporting method	Sample frame
Study	Country (region)	Study period	Number of cases
SA	Caucasian					Diagnosis based on recognised criteria	Ethnicity reporting method	Sample frame

Crohn's disease
Fellows (1985)[11]	United Kingdom (Derby)	1966-1985	221	4.4	7.5	No	Self-reported	Hospital
Probert (1992)[6]	United Kingdom (East London)	1970-79	45	1.2	3.8	Yes	Medical records	Hospital
Probert (1992)[6]	United Kingdom (East London)	1980-89	54	2.3	3.8	Yes	Medical records	Hospital
Jayanthi (1992)[17]	United Kingdom (Leicester)	1972-1980	80	1.2	3.5	Yes	Surname	Population
Jayanthi (1992)[17]	United Kingdom (Leicester)	1981-1989	104	3.1	5.3	Yes	Surname	Population
Pinsk (2007)[12]	Canada (Vancouver)	1985-2005	397 (Paed)	6.7	1.0	Yes	Medical records	Hospital
Benchimol¹ (2015)[13]	Canada (Ontario)	1994-2010	12113	5.0	11.3	No	Medical records	Population
Ulcerative colitis
Probert (1992)[5]	United Kingdom (Leicester)	1972-1989	1003	10.8	5.3	No	Surname	Population
Jayanthi (1992)[14]	United Kingdom (East London)	1972-1989	112	1.8	6.2	No	Medical records	Hospital
Carr (1999)[15]	United Kingdom (Leicester)	1991-1994	74	17.2	9.1	Yes	Self-reported	Population
Pinsk (2007)[12]	Canada (Vancouver)	1985-2005	120 (Paed)	6.4	3.7	No	Medical records	Hospital
Probert (1985)[16]	Fiji	1985-1986	15	1.5	0.2	No	Medical records	Hospital
Benchimol¹(2015)[13]	Canada (Ontario)	1994-2010	12713	2.0	11.4	No	Medical records	Population

¹SA compared to non-immigrant. Characteristics of studies comparing South Asian (SA) migrants and Caucasians.

Table 2 Prevalence of Crohn’s disease: Study characteristics and comparison between Caucasian and other migrant groups

Study characteristics									Study quality characteristics
Study	Country (region)	Study period	Number of cases	Prevalence rate, cases/100000					Diagnosis based on recognised criteria	Ethnicity reporting method	Sample frame

				SA	Asian	Caucasian	Black	Hispanic	Diagnosis based on recognised criteria	Ethnicity reporting method	Sample frame

Probert (1993)[18]	United Kingdom (Leicester)	1989	676	33.2	-	75.8	-	-	Yes	Self-reported	Population
Kurata (1992)[19]	United States (California)	1982-1988	169	-	5.6	43.6	29.8	4.1	No	Medical records	Hospital
Wang (2013)[20]	United States (National Database)	1996-2007	204	-	45.0	154.0	68.0	15.0	No	Self-reported	Population

SA: South Asian.

Table 3 Prevalence of ulcerative colitis: Study characteristics and comparison between population groups

Study characteristics									Study quality characteristics
Study	Country (region)	Study period	Number of cases	Prevalence rate, cases/100000					Diagnosis based on recognised criteria	Ethnicity reporting method	Sample frame

				SA	Asian	Caucasian	Black	Hispanic

Probert (1993)[18]	United Kingdom (Leicester)	1989	888	136.0	-	90.8	-	-	Yes	Self-reported	Population
Wang (2013)[20]	United States (National database)	1996-2007	108	-	40.0	89.0	25	35	No	Self-reported	Population
				SA	Malay	Chinese	Black	Hispanic
Lee (2000)[21]	Singapore (Singapore)	1985-1996	58	16.2	7.0	6.0	-	-	Yes	Self-reported	Hospital

SA: South Asian.

Table 4 Meta-analysis of incidence studies showing rate ratio of South Asians relative to Caucasians

Disease	Number of studies	Heterogeneity		Effect size
Disease	Number of studies	I²	P value	RR (95%CI)	P value
Crohn’s disease	6	95%	< 0.001	0.78 (0.22, 2.78)	0.7
Ulcerative colitis	4	83%	0.001	1.39 (0.84, 2.32)	0.2

Table 5 Crohn’s disease location and behaviour

Study	Country (Region)	Time period	Number of cases	Montreal classification	Population groups, %
					SA	Caucasian
Location
Walker (2011)[35]	United Kingdom (NW London)	2008-2010	309	L1	16.0	24.7
				L2	46.8	34.8
				L3	37.2	40.5
				L4	0.0	0.0
Goodhand (2012)[36]	United Kingdom (East London)	2010	141	L1	33.0	32.0
				L2	24.0	43.0
				L3	38.0	22.0
				L4	18.0	13.0
Li (2013)[22]	United States (San Francisco)	1994-2009	57 (Paed)	L1	7.7	14.9
				L2	38.5	23.4
				L3	53.9	61.7
				L4	15.4	5.3
Carroll (2016)[38]	Canada (British Columbia)	1997-2012	638 (Paed)	L1	6.0	9.0
				L2	55.0	35.0
				L3	39.0	55.0
				L4a	55.0	43.0
				L4b	1.0	9.0
				L4ab	0.0	8.0
Behaviour
Walker (2011)[35]	United Kingdom (NW London)	2008-2010	309	B1	72.3	58.1
				B2	22.0	60.0
				B3	4.3	14.0
				Perianal	20.2	21.4
Goodhand (2012)[36]	United Kingdom (East London)	2010	141	B1	63.0	55.0
				B2	15.0	11.0
				B3	20.0	15.0
				Perianal	16.0	3.0
Li (2013)[22]	United States (San Francisco)	1994-2009	57 (Paed)	Perianal	46.2	12.8
Carroll (2016)[38]	Canada (British Columbia)	1997-2012	638 (Paed)	B1	61.0	73.0
				B2	13.0	16.0
				B3	6.0	3.0
				B2B3	21.0	9.0

South Asians compared with Caucasians. Total No. of cases reported was 1145. Significant difference in disease behaviour illustrated in bold.

Table 6 Crohn’s disease location

Study	Country (Region)	Time period	Number of cases	Disease location/ Behaviour, Montreal	Population groups, %
					AA	Caucasian (or other control)	Hispanic
Cross (2006)[23]	United States (Baltimore)	1997-2005	210	L1	13.0	38.0	-
				L2	29.0	23.0	-
				L3	56.0	36.0	-
Sofia (2014)[40]	United States (Chicago)	2008-2013	1334	L1	57.8	71.0	-
Sofia (2014)[40]	United States (Chicago)	2008-2013	1334	L2	60.6	66.0	-
Nguyen (2006)[24]	United States (National)	2003-2005	697	L1	16.1	29.2	23.3
				L2	33.9	17.4	16.3
				L3	22.6	36.7	52.3
				L4	27.4	16.7	8.1
Eidelwein (2007)[25]	United States (Baltimore)	1991-2000	137 (Paed)	L1	3.0	2.9	-
				L2	73.5	71.8	-
				L3	23.5	25.2	-
Hatter (2012)[26]	United States (Texas)	2004-2009	246 (Paed)	L1	4.3	4.7	4.8
				L2	7.1	4.8	10.5
				L3	87.8	88.9	84.2
Ghazi (2013)[27]	United States (Baltimore)	2004-2009	296	L1	31.0	38.0	-
				L2	12.0	20.0	-
				L3	55.0	42.0	-
Damas (2013)[28]	United States (Florida)	1998- 2009	325	L1	-	16 (NHW)	24.4
				L2	-	24.0	25.6
				L3	-	60.0	50.0
				L4	-	12.5	3.9
Kugathasan (2003)[29]	United States (National)	2000-2001	222 (Paed)	L1	10.0	19.0	-
				L2	34.0	28.0	-
				L3	46.0	51.0	-
				L4	32.0	42.0	-

AA or Hispanics compared with Caucasians (3467 total cases). Bold font shows significant differences between AA and population group. Italic font illustrates significant difference between Hispanic and Caucasian groups. AA: African-Americans; NHW: Non-Hispanic white.

Table 7 Crohn’s disease behaviour

Study	Country (Region)	Time period	Number of cases	Disease location/ Behaviour, Montreal	Population groups, %
					AA	Caucasian	Hispanic
Nguyen (2006)[24]	United States (National)	2003-2005	697	B1	53.2	48.0	45.3
				B2	27.9	21.4	23.6
				B3	19.0	30.6	31.1
				Perianal	40.0	28.7	52.5
Eidelwein (2007)[25]	United States (Baltimore)	1991-2000	137 (Paed)	B2 + B3	29.1	11.11	-
Ghazi (2013)[27]	United States (Baltimore)	2004-2009	296	B1	18.0	33.0	-
				B2	42.0	36.0	-
				B3	40.0	31.0	-
				Perianal	36.0	25.0	-
Sofia (2014)[40]	United States (Chicago)	2008-2013	1334	Perianal	25.7	24.7	-
Damas (2013)[28]	United States (Florida)	1998- 2009	325	B1	-	81.5 (NHW)	78.9
				B2	-	0.0	1.1
				B3	-	18.5	20.0
				Perianal	-	27.0	23.0
Kugathasan (2005)[29]	United States (National)	-	222 (Paed)	Inflammatory	58.0	64.0	-
				Stricturing	20.0	18.0	-
				Fistulising	22.0	18.0	-
				Perianal	23.0	36.0	-
Malaty (2010)[30]	Houston (Texas)	2000-2006	273	Inflammatory	64.0	63.0	58.0
				Stricturing	16.0	17.0	13.0
				Fistulising	17.0	16.0	32.0
Adler (2016)[31]	Multicentre (United States and United Kingdom)	2006-2014	2034 (Paed)	Perianal	26.0	20.0	24.0

AA or Hispanics compared with Caucasians (5318 cases). Italic font illustrates significant differences between hispanic and population group. Bold font shows significant differences between AA and other population group. AA: African-Americans.

Table 8 Ulcerative colitis in Caucasian and South Asian migrant groups (1054 cases)

Study	Country (Region)	Study period	Number of cases	Disease extent, Montreal	Ethnic groups, %
					SA	Caucasian (or other control)
Adult
Carr (1999)[15]	United Kingdom (Leicester)	1991-1994	74	E1 + E2	63.7	68.3
Carr (1999)[15]	United Kingdom (Leicester)	1991-1994	74	E3	36.3	31.7
Rashid (2008)[37]	United Kingdom (Manchester)	2008	82	E3	41.0	26.0
Walker (2011)[35]	United Kingdom (NW London)	2008-2010	461	E1	9.9	26.1
				E2	27.1	31.4
				E3	63.0	42.0
Goodhand (2012)[36]	United Kingdom (East London)	2010	89	E1	2.0	31.0
Goodhand (2012)[36]	United Kingdom (East London)	2010	89	E3	60.0	33.0
Hilmi (2009)[39]	Malaysia (Malaysia)	2004-2005	118	E1 + 2	39.6	56.7 (Malay)
Hilmi (2009)[39]	Malaysia (Malaysia)	2004-2005	118	E3	60.4	43.4 (Malay)
Paediatric
Carroll (2016)[38]	Canada (British Columbia)	1997-2012	230	E1	3.0	5.0
				E2	9.0	19.0
				E3	12.0	18.0
				E4	77.0	58 (Non-South Asian)

Adult and paediatric studies on disease extent. Bold font shows significant differences between AA and population group (809/1054 cases). AA: African-American; SA: South Asian.

Table 9 Ulcerative colitis in AA and Hispanic groups (1787 cases)

Study	Country (Region)	Time period	Number of cases	Disease extent	Ethnic groups, %
Study	Country (Region)	Time period	Number of cases	Disease extent	AA	Caucasian	Hispanic
Adult studies
Basu (2005)[32]	United States (Texas)	1999-2003	61	E1	-	32.0	8.0
Basu (2005)[32]	United States (Texas)	1999-2003	61	E2 + 3	-	68.0	86.0
Nguyen (2006)[24]	United States (National database)	2003-2005	396	E1	13.8	5.9	3.6
				E2	16.4	31.4	34.5
				E3	51.7	62.7	80.0
Eidelwein (2007)[25]	United States (Baltimore)	1991-2000	40	E1 + 2	0.0	10.0	-
Eidelwein (2007)[25]	United States (Baltimore)	1991-2000	40	E3	100.0	23.0	-
Moore (2012)[33]	United States (Ohio)	2000-2010	311	E1	14.5	6.5	-
				E2	44.7	30.7	-
				E3	40.8	62.9	-
Sofia (2014)[40]	United States (Chicago)	2008-2013	541	E1	17.9	11.1	-
				E2	28.6	32.0	-
				E3	50.0	51.5	-
Damas (2013)[28]	United States (Florida)	1999-2009	138	E1	-	11.8	12.5
				E2	-	29.4	46.2
				E3	-	58.8	41.3
Paediatric
Flasar (2008)[34]	United States (Baltimore)	1997-2005	197	E1	23.0	10.0	-
				E2	23.0	31.0	-
				E3	53.0	59.0	-
Hatter (2012)[26]	United States (Texas)	2004-2009	103	E1 + 2	7.1	15.4	18.8
Hatter (2012)[26]	United States (Texas)	2004-2009	103	E3	81.3	84.6	81.3

Adult and paediatric studies on disease extent. Italic font illustrates significant difference between Hispanic and Population group. Bold font shows significant differences between AA and population group. AA: African-American.

Citation: Misra R, Faiz O, Munkholm P, Burisch J, Arebi N. Epidemiology of inflammatory bowel disease in racial and ethnic migrant groups. World J Gastroenterol 2018; 24(3): 424-437
URL: https://www.wjgnet.com/1007-9327/full/v24/i3/424.htm
DOI: https://dx.doi.org/10.3748/wjg.v24.i3.424