Beyond the Bowel: Novel Comorbidity Patterns in Inflammatory Bowel Disease from the All of Us Research Program

BackgroundInflammatory bowel disease (IBD) manifests systemically, yet most comorbidity studies rely on predominantly European populations. The All of Us Research Program enables investigation across demographically diverse groups. MethodsWe matched 5,094 IBD patients 1:4 with controls by age, gender, and race, analyzing comorbidities using logistic regression with Mantel-Haenszel adjustment. Multiple testing correction used false discovery rate (FDR) with significance thresholds of OR >1.5 or <0.5 and FDR <0.05. ResultsOur cohort included 29.2% non-White participants versus 10-15% in traditional studies. We identified 22 significant associations across seven organ systems. Three novel discoveries included delayed postmyocardial infarction pericarditis (adjusted OR = 4.80), contact dermatitis (adjusted OR = 1.84), and carotid artery aneurysm (adjusted OR = 2.21). Other significant associations included drug-induced lupus (adjusted OR = 4.32), autoimmune hepatitis (adjusted OR = 2.43), and restricting-type eating disorders (adjusted OR = 4.00). IBD patients showed decreased obesity-related conditions. ConclusionThis demographically diverse study discovered novel IBD comorbidities and confirmed established associations across racial groups. Findings support reconceptualizing IBD as a multisystem disorder requiring comprehensive management and demonstrate the importance of diverse research populations.