Inflamm Bowel Dis. 2020 Jun 18;26(7):1068-1076. doi: 10.1093/ibd/izz225.

Mahesh Krishna ^1 2, Aziza Salako ¹, Tatiana Fofanova ³, Richard Kellermayer ^2 4

Author information

• ¹Wiess School of Natural Sciences, Rice University, Houston, TX, USA.
• ²Section of Pediatric Gastroenterology, Baylor College of Medicine, Houston, TX, USA.
• ³Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.
• ⁴USDA/ARS Children's Nutrition Research Center, Texas Children's Hospital, Houston, TX, USA.

Abstract

Background: The incidence of pediatric inflammatory bowel diseases (PIBDs: Crohn's disease [CD], ulcerative colitis [UC]) is on the rise around the world. Yet, the critical risk factors for this rising incidence are not well understood. Demographic characteristics of PIBD may improve our understanding of their developmental origins and aid in prevention.

Methods: Four hundred eighty-eight consecutive PIBD patients diagnosed at Texas Children's Hospital from 13 counties around Houston were studied. An annual incidence map was created by ZIP code of residence at diagnosis by using ArcGIS and the American Community Survey from the US Census Bureau. Correlation between demographic variables and PIBD incidence was examined. A model to explain incidence from different health factors was created in R.

Results: Hispanic children were more likely to be diagnosed with UC (P < 0.01) and unclassified IBD (IBD-U) (P < 0.03) compared with other races/ethnicities. A significant positive correlation (r = 0.35, P < 0.0001) between median household income and PIBD incidence was observed (UC: r = 0.23, P < 0.0001; CD: r = 0.22, P = 0.0004). ZIP codes with majority college-educated adults had a higher incidence of PIBD than ZIP codes with majority high school-educated adults (P < 0.0001). Pediatric cases with CD were more common in ZIP codes where the majority of adults were college educated (P < 0.0001). Pediatric cases with UC, however, were more common in ZIP codes where the majority of adults were high school educated (P = 0.0036).

Conclusions: Hispanic children more commonly present with UC and IBD-U in southern USA. Household income and/or adult education-related environmental/dietary differences may be important in the developmental origins of PIBD in large metro areas, such as Houston.