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P630 Inflammatory bowel disease in immigrants to Spain: results of the EIIMIGRA study from GETECCU (ENEIDA registry)

Gutiérrez Casbas, A.(1);Zapater, P.(2);Ricart, E.(3);González-Vivó, M.(4);Gordillo, J.(5);Olivares, D.(6);Vera-Mendoza, I.(7);Mañosa, M.(8);P. Gisbert, J.(9);Aguas, M.(10);Sánchez-Rodríguez, E.(11);Boscá, M.(12);Laredo, V.(13);Camps, B.(14);Marín-Jíménez, I.(15);Zabana, Y.(16);Martín-Arranz, M.D.(17);Muñoz, R.(18);Navarro-Llavat, M.(19);Sierra, E.(20);Madero, L.(21);Vela, M.(22);Pérez-Calle, J.(23);Sainz, E.(24);Calvet, X.(25);Sicilia, B.(26);Morales, V.(27);Bermejo, F.(28);Fernández-Salazar, L.(29);Van Domselaar, M.(30);De Castro, L.(31);Rodríguez, C.(32);Muñoz-Villafranca, C.(33);Lorente, R.(34);Rivero, M.(35);Iglesias, E.(36);Herreros, B.(37);Barreiro-de-Acosta, M.(38);Domènech, E.(39);Francés, R.(40);

(1)Hospital General Universitario Alicante- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd- Instituto de Investigación Sanitaria y Biomédica de Alicante ISABIAL, Gastroenterology, Alicante, Spain;(2)Hospital General Universitario Alicante- ISABIAL- CIBERehd- Universidad Miguel Hernández Elche, Clinical Pharmacology, Alicante, Spain;(3)Hospital Clínic i Provincial de Barcelona- CIBERehd, Gastroenterology, Barcelona, Spain;(4)Parc de Salut Mar, Gastroenterology, Barcelona, Spain;(5)Hospital de la Santa Creu i Sant Pau, Gastroenterology, Barcelona, Spain;(6)Hospital Universitario Clínico San Carlos, Gastroenterology, Madrid, Spain;(7)Hospital Universitario Puerta de Hierro Majadahonda, Gastroenterology, Madrid, Spain;(8)Hospital Universitari Germans Trials i Pujol- Badalona and CIBERehd, Gastroenterology, Badalona, Spain;(9)Hospital Universitario de La Princesa- Instituto de Investigación Sanitaria Princesa IIS-IP- Universidad Autónoma de Madrid UAM- CIBERehd, Gastroenterology, Madrid, Spain;(10)Hospital Universitari i Politecnic La Fe- CIBERehd, Gastroenterology, Valencia, Spain;(11)Hospital Universitario Ramón y Cajal, Gastroenterology, Madrid, Spain;(12)Hospital Clínico Universitario de Valencia- Universitat de València, Gastroenterology, Valencia, Spain;(13)Hospital Clínico Universitario “Lozano Blesa”- IIS Aragón, Gastroenterology, Zaragoza, Spain;(14)Hospital Universitario de Bellvitge, Gastroenterology, Barcelona, Spain;(15)Hospital General Universitario Gregorio Marañón- Instituto de Investigación Biomédica Gregorio Marañón IiSGM, Gastroenterology, Madrid, Spain;(16)Hospital Universitari Mutua Terrasa- CIBERehd, Gastroenterology, Barcelona, Spain;(17)Hospital Universitario La Paz, Gastroenterology, Madrid, Spain;(18)Hospital General Universitario Alicante, Gastroenterology, Alicante, Spain;(19)Hospital de Sant Joan Despí Moisès Broggi, Gastroenterology, Barcelona, Spain;(20)Hospital Universitario Miguel Servert, Gastroenterology, Zaragoza, Spain;(21)Hospital General Universitario de Elche, Gastroenterology, Elche, Spain;(22)Hospital Universitario Nuestra Señora de la Candelaria, Gastroenterology, Santa Cruz de Tenerife, Spain;(23)Hospital Universitario Fundación de Alcorcón, Gastroenterology, Madrid, Spain;(24)Althaia Xarxa Assistencial i Universitària de Manresa- Barcelona, Gastroenterology, Barcelona, Spain;(25)Hospital Universitari Parc Taulí- Sabadell. Departament de Medicina- Universitat Autònoma de Barcelona- CIBERehd, Gastroenterology, Barcelona, Spain;(26)Hospital Universitario de Burgos, Gastroenterology, Burgos, Spain;(27)Hospital General de Granollers, Gastroenterology, Barcelona, Spain;(28)Hospital Universitario de Fuenlabrada and Instituto de Investigación Sanitaria Hospital La Paz IdiPaz-Madrid, Gastroenterology, Madrid, Spain;(29)Hospital Clínico Universitario de Valladolid, Gastroenterology, Valladolid, Spain;(30)Hospital de Torrejón de Ardoz, Gastroenterology, Madrid, Spain;(31)Xerencia Xestion Integrada de Vigo- SERGAS. Vigo. Research Group in Digestive Diseases- Galicia Sur Health Research Institute IIS Galicia Sur. SERGAS-UVIG, Gastroenterology, Vigo, Spain;(32)Complejo Hospitalario de Navarra, Gastroenterology, Pamplona, Spain;(33)Hospital Universitario de Basurto, Gastroenterology, Bilbao, Spain;(34)Hospital General Universitario de Ciudad Real, Gastroenterology, Ciudad Real, Spain;(35)Hospital Universitario Marqués de Valdecilla and IDIVAL, Gastroenterology, Santander, Spain;(36)Hospital Universitario Reina Sofía- IMIBIC, Gastroenterology, Córdoba, Spain;(37)Hospital Marina Baixa, Gastroenterology, Villajoyosa, Spain;(38)Complexo Hospitalario Universitario de Santiago- Santiago de Compostela, Gastroenterology, Santiago de Compostela, Spain;(39)Hospital Universitari Germans Trials i Pujol- CIBERehd, Gastroenterology, Badalona, Spain;(40)Universidad Miguel Hernández- Elche- Instituto Investigación Sanitaria y Biomédica de Alicante ISABIAL- CIBERehd, Clinic Medicine- Immunology, Alicante, Spain; EIIMIGRA

Background

Previous studies comparing inflammatory bowel disease(IBD) features between migrant and native patients have shown clinical phenotype differences. To date, no study has focused on IBD immigrants(MP) in Spain. The aim of this study was to explore the features of MP in Spain and to compare age of disease onset, IBD phenotype and therapeutic requirements with native-born IBD patients(NP).

Methods

This was an observational, multicentric and case-control study of the nationwide ENEIDA registry. We selected all IBD patients who were born outside of Spain and compared with a control cohort of NP. All included patients were diagnosed with IBD before 2015.

Results

A total of 13,524 patients were included(1864 MP and 11660 NP).The most prevalent ethnic migrant group was Caucasian(771, 41%), followed by Latin American(572, 31%) and Arabian(341,18%), whereas Asian represented only 6%. Table 1 summarizes the demographic and phenotypic features. 71% of MP were diagnosed with IBD in Spain. There was not a gender predisposition to IBD in the overall migrant group, however more female UC MP were detected compared to UC NP(52 % vs 45%, p<0.001). MP were younger at the onset of the disease and had a shorter disease duration compared to NP, in both UC and CD patients. Significantly more CD patients were diagnosed under 16 years(A1) among MP, and more patients over 40 years(A3) among NB. More NB patients had CD stricturing phenotype(24% vs 19%, p=0,002) compared to MP. Disease extension in CD and UC did not differ between groups. The overall proportion of abdominal or perianal surgery was similar in both groups but the use of biologic therapy was more common in MP(36% vs 30%, p=0,001).

Table 1 

Immigrants  n:1864Natives  n:11660P
Gender, % female936 (50.2) 5444 (46.7) 0.005
Current median age, yr (SD)45.3 (12.6) 54.5 (16.0 )<0.001
Median age at diagnosis, yr (SD)31.2 (12.0) 36.5 (15.6)  <0.001
Median disease duration (yr)(SD)14.0 (7.2) 18.0 (8.7)  <0.001 
UC/CD, n(%)1029 (55.4) /777 (41.8)6665 (57.2)/4755 (40.8) 0.068
CD age at diagnosisA1/A2/A3 n(%)67 (8.6)/586 (75.3)/125 (16.1 275 (5.8)/3223 (67.8)/257 (26.4) <0.001 
CD location L1/L2/L3 n(%)154 (28.5)/112 (20.7)/233 (43.1)1025 (28.4)/640 (17.7)/1636 (45.3)  0.368
CD behaviourB1/B2/B3 n(%)482(63.9)/144(19)/128(17)2744(57.7)/1158(24.4)/853(17.9)0.002
Perianal disease n(%)242 (13.7) 1776 (15.4) 0.069
UC extension E1/E2/E3, n(%)83 (13.3) /186 (29.7)/357 (57.0)  459 (9.9) /1478 (31.9) /2689 (58.1) 0.031

Conclusion

In the largest cohort of migrant IBD patients in Spain, immigrants were younger, had a shorter disease duration and required a higher use of biologics than natives, pointing phenotypic differences in this population and a universal access to the healthcare system all over the country.

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