Impacto da raça e ancestralidade na apresentação e evolução da doença de Crohn no Brasil / The impact of race and ancestry in the presentation and progression of Crohns disease in Brazil

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

INTRODUCTION: Crohns disease (CD) is increasingly recognized in diverse ethnic populations. Ethnic factors related do CD are highly controversial. Apparently, there seems to be a higher incidence among white subjects. However, studies conducted in USA have shown an increase in prevalence among black subjects in the last 30 years. Overall, there is lack of information concerning the clinical phenotype (disease presentation and progression) so as to race, and literature remains controversial. Brazil has a multiracial society, with important European immigration and also Africans. AIM: to analyze the influence of race and/or ancestry on clinical presentation and progression in a multiracial society living in the same environment. METHODS: Two hundred and seventy three patients with CD seen in gastroenterology clinic of Hospital das Clínicas between June 2005 and July 2006 were analyzed to determine whether there were significant differences among racial/ancestry groups. Race was self-declared according to the classification used by IBGE (Brazilian Demographical Census classifies people according to race or skin color, which is declared by the person himself/herself according to the fallowing options: white, black, brown/mixed, yellow or indian). Ancestry (also declared by the patient) was described as European, African, mixture of African and European, Indian, Asian or another/unknown. The definition of disease location was according to the Vienna classification. The severity of disease was measured by the use of steroids, the use of immunomodulators (azathioprine or methotrexate) and the need of surgeries related to the disease. The evaluation of extra-intestinal manifestations consisted of 3 main categories: ophthalmological, dermatological and articular. Statistical analyses were performed by SPSS statistic software. RESULTS: Whites comprised 68.8%, blacks 7.8%, brown/mixed 21.5% and yellow 1.5%. One patient reported itself as American Indian. Comparing the whites and the African Americans (blacks and brown/mixed), we found no significant difference with respect to family history of inflammatory bowel disease (16.2% vs 7.6%; p=0.08), mean age at the onset of symptoms (27+12 vs 30+12; p=0.07), steroids use (73.9% vs 65.7%; p=0.21), immunomodulators use (74.3% vs 74%; p=0.96), surgery need (53.2% vs 46.2; p=0.34), perforating disease (43.5% vs 48.7%; p=0.49), ocular manifestations (8.8% vs 9.0%; p=0.96), skin manifestations (15.5 vs 15.8%; p=0.94), articular (64.5% vs 63.3% p=0.89). Smoking habits, a possible confounding factor, was similar in the two groups. The whites have more frequent disease location at the ileum (42.4% vs 23.4%; p= 0.009). Analyzing the ancestry, there were 36.8% European, 3.8% mixture of African and European, 9.2% African, 7.9% Indian, 1.3 Asian and 41% Brazilian/other/unknown. If we analyze the European ancestry compared to African, there were no significant difference. CONCLUSIONS: There were no significant differences among the races (as defined by skin color) in most of the studied variables. There were difference only in respect to disease location, as described previously by others. It seems that in a multiracial society as Brazil, race, in respect of skin color or ancestry, may have some influence, but it is not an important factor defining presentation or progression of CD.

ASSUNTO(S)

doença de crohn/epidemiologia grupos de populações continentais continental population groups doença de crohn/diagnóstico distribuição por raça ou etnia race or ethnic group distribution crohn disease/diagnosis crohn disease/epidemiology

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