vertebrae colored with different skin tones

Racial Differences In AS Experience

In 2019, the Journal of Rheumatology published a review of information from a large database of people with ankylosing spondylitis (AS). Researchers found that AS may be worse in people who identify as black and they are more likely to have other health conditions than people who identify as white.1

What the numbers say

The authors looked at data from over 50 million people who were treated at 26 health care systems in the United States.1 The researchers used that database to pull information from 1999-2017 for 10,990 people with AS. Each person had made at least 2 visits to a rheumatologist. They reviewed this data to see if there were any racial differences in people with AS.1

AS more severe in people who identify as black and/or African American

Most of the patients were white, making up 84 percent of the group, and 8 percent were African American. Both groups had an equal amount of men and women. Both had a similar percent who tested positive for human leukocyte antigen B27 (HLA-B27). Overall, 65 percent of those in the study smoked. White people were more likely to be smokers.1

The data shows that AS may be more severe in African Americans. Significantly more black patients showed higher inflammation rates (62 percent for blacks and 48 percent of whites). They also had higher levels of C-reactive protein levels (68 percent for blacks and 54 percent for whites), which also indicate inflammation.1

Other diseases more likely too

African American patients were more likely to have other diseases in addition to AS. Health conditions that were significantly more common in African Americans with AS included:1

  • Inflammation of part of the eye (8 percent vs. 4 percent)
  • High blood pressure (29 percent vs. 22 percent)
  • Diabetes (27 percent vs. 17 percent)
  • Depression (36 percent vs. 32 percent)

Other conditions that were seen more often in African Americans with AS were:1

  • Arthritis in the arm and leg joints
  • Problems with the connections between tendons, ligaments, and bones (also called enthesitis)
  • Inflammation of the fingers or toes
  • Inflammatory bowel disease

Caucasians with AS were significantly more likely to have psoriasis (10 percent vs. 6.5 percent) than African Americans.1

More research is needed

According to the researchers, genetics are thought to be responsible for how severe AS becomes. However, there may be other reasons for the racial differences seen in the health of African Americans and white people, including cultural, social, or economic factors. The authors noted that more research is needed so that doctors can better address the health needs of people who identify as black or African American with AS.1

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