Characterization of a Large Hispanic Cohort With Inflammatory Bowel Disease Across a 26‐Year Span: The University of Puerto Rico Registry
Alondra Soto‐González, Lizzie M. Ramos‐Tollinchi, Claudia Amaya‐Ardila, Paola López‐Marte, Andrea Sánchez‐Velázquez, Karla Feliciano‐Salva, María T. Anca‐Fullana, Patricia Figueroa‐Rodríguez, Esther A. TorresABSTRACT
Background and Aims
The limited data on ethnic minorities with inflammatory bowel disease (IBD) is a growing concern, given its increasing incidence in Hispanics in the United States and Latin America. Our aim was to describe a large cohort of Hispanics with IBD studied over two decades.
Methods
The University of Puerto Rico IBD Registry has been recruiting patients since 1995. We describe a cohort of Hispanic patients recruited from 1995 through 2020, compared by time period (1995–2009 vs. 2010–2020) and diagnosis. The variables included sex, age, age at the onset of symptoms, IBD diagnosis, disease extent, family history of IBD, smoking history, extraintestinal manifestations, medications, and history of surgery for IBD. Descriptive statistics included frequencies, medians, means, and standard deviations.
Results
We included 1365 Hispanic patients; 845 (62%) had Crohn's disease (CD), 520 (38%) had ulcerative colitis, and 710 (52%) were male. Compared with the 1995–2009 cohort, the proportion of CD diagnoses increased significantly in 2010–2020 (53.7%–68.1%; p < 0.001). Use of anti‐tumor necrosis factor (anti‐TNF) agents rose markedly from 10.2% to 58.4% and immunomodulators from 18.2% to 32.1% (both p < 0.001), while aminosalycylates and corticosteroids declined ( p < 0.001). Corticosteroids and antibiotics use remained stable with no significant change. Overall extraintestinal manifestation decreased from 36.3% to 25.5% ( p < 0.001) and family history of IBD increased in both diagnostic groups. IBD‐related surgery rate remained stable. For CD cases, the disease extent changed significantly between the two time cohorts, with most cases having ileocolonic (38.3% vs. 46.9%) or ileal (36.7% vs. 33.9%) inflammation. Perianal disease decreased from 26.7% to 16.8%. CD disease behavior showed significant change, 62.4% of CD cases had a penetrating disease (83.0% vs. 52.1%), 24.8% stricturing (13.8% vs. 30.3%), and 12.8% non‐stricturing/non‐penetrating (3.2% vs. 17.6%). UC disease extent (480/528) showed no significant difference with the majority of cases having pancolitis (51.6% vs. 53.0) or left‐sided colitis (21.0% vs. 21.4) in both time cohorts ( p = 0.481).
Conclusions
Differences over time may reflect changes in disease phenotypes, environmental influences, the impact of physician awareness and healthcare access, and/or new management guidelines and therapies. Temporal trends should be interpreted cautiously in light of Puerto Rico's aging population and substantial out‐migration. The increase in IBD in Hispanics in the US and Latin America warrants further studies to better characterize this population, explore outcomes, and define ethnic differences and disparities in this cohort.