Background/Purpose: Racial/ethnic disparities in Behçet’s disease (BD) outcomes are largely undocumented in the United States. Given known differences in disease expression across populations globally, we used a large real-world database to evaluate potential disparities in cardiovascular, ocular, and treatment outcomes between White and Black/Hispanic (B-His) patients with BD.

Methods: Using TriNetX Global Collaborative Network, we conducted a retrospective cohort study. Adults (≥18 years) with ICD-10 BD (M35.2) were assigned to a White or B-His cohort based on electronic health records (EHR) and matched 1:1 on age, sex and ten cardiometabolic comorbidities, yielding 1400 patients per group. Outcomes captured 1 day–10 years after the index BD diagnosis were- stroke, heart failure (HF), myocardial infarction (MI), venous/arterial thrombosis, uveitis, all-cause death and exposures to systemic corticosteroids, tumour-necrosis-factor (TNF) inhibitors and non-biologic immunosuppressants. Between-group differences were assessed using risk ratios (RRs) with 95% confidence intervals (CIs) and Kaplan–Meier survival analysis with log-rank tests.

Results: Groups were well balanced after matching (standardised differences < 0.03). Over the follow-up period, B-His patients experienced nearly twice the stroke incidence of White patients (3.9 % vs 1.7 %; RR 0.43, 0.26–0.69; p = 0.001) and a similar pattern for HF (4.6 % vs 2.5 %; RR 0.54, 0.36–0.82; p = 0.007). Although MI, thrombosis, seizures and death did not differ significantly, the directionality of the outcomes numerically favoured the White group. Uveitis occurred in 9.6 % of B-His and 6.4 % of White patients (RR 0.66, 0.51–0.86; p = 0.002). Therapeutic patterns also diverged: B-His patients were more likely to receive systemic corticosteroids (51 % vs 44 %; RR 0.86, 0.77–0.96; p = 0.009) and TNF inhibitors (13 % vs 10 %; RR 0.77, 0.63–0.95; p = 0.014), while non-biologic immunosuppressant use was similar between cohorts. Kaplan–Meier curves confirmed lower cumulative hazards for stroke, HF and uveitis in White patients (log-rank p ≤ 0.01); survival did not differ significantly.

Conclusion: In this nationwide, propensity-matched analysis, White adults with Behçet’s disease experienced significantly fewer strokes, HF events, ocular flares and immunosuppressive courses than Black/Hispanic adults, despite equivalent baseline characteristics. The data highlights racial disparities in both disease burden and treatment intensity. Further investigation into genetic susceptibility, care delivery inequities, and social determinants of health is essential to inform equitable, evidence-based management strategies for diverse BD populations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/racial-disparities-in-cardiovascular-ocular-and-treatment-outcomes-in-us-patients-with-behcets-disease-a-propensity-matched-real-world-analysis/