Racial Differences Among Concurrent Diagnosis of Inflammatory Bowel Disease and Colorectal Carcinoma: An Analysis of the National Inpatient Sample 2016-2020

Background: The incidence of inflammatory bowel disease is highest regionally in North America and lower in African and Asian countries. However, the prevalence of inflammatory bowel disease (IBD) has been increasing worldwide, particularly among non-White populations. Similarly, the risk of colorectal cancer has grown as well. It has been well established that IBD is a risk factor for developing colorectal cancer (CRC). The aim of this study is to investigate demographic differences in the development of colorectal cancer in patients with IBD. Methods: The National Inpatient Sample (NIS) database (2016-2020) was analyzed to identify adult patients admitted with ICD-10 codes for Crohn’s disease, Ulcerative colitis, IBD, and colorectal cancer. Multivariate logistic/linear regressions were used to estimate concurrence of IBD, Crohn’s disease, and Ulcerative colitis with CRC among different races. Patient age, gender, and primary insurance status were controlled. Weighted analysis with Stata 17MP was performed. Results: A total of 313,778 adult patients were identified with IBD. We found that among patients with Crohn’s disease, African American patients were 23.1% less likely (OR 0.77, P< 0.05, CI 0.63-0.94) to have concurrent CRC and IBD when compared to White patients. Similarly, among patients with Ulcerative colitis, African American patients were 33.9% less likely (OR 0.66, P< 0.01, CI 0.54-0.81) to have concurrent CRC. Conversely, Asian patients with Ulcerative colitis were 74.4% more likely (OR 1.74, P< 0.01, CI 1.28-2.38) to have CRC when compared to White patients. When considering all patients with IBD, African American patients were 28.2% less likely (OR 0.72, P< 0.01, CI 0.62-0.83) and Asians were 68.2% more likely (OR 1.68, P< 0.01, CI 1.28-2.20) to have CRC when compared to White patients. Conclusions: Among patients with Crohn’s disease and/or Ulcerative colitis, African American patients were significantly less likely to develop concurrent CRC. However, Asian patients were much more likely to have a concurrent diagnosis of CRC. Further studies analyzing genetic and environmental factors impacting these clinical outcomes would help further understanding and guide treatment methods in the future.