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Sunday Poster Session

Category: Esophagus

P0423 - Use of Esophagogastroduodenoscopy for Upper Gastrointestinal Bleeding Among Whites, Blacks, and Hispanics and Associated Disparities

Sunday, October 22, 2023
3:30 PM – 7:00 PM PT
Location: Exhibit Hall
Harpreet Kaur, MBBS1, Renuka Verma, MBBS2, Kamleshun Ramphul, MD3, Hemamalini Sakthivel, MD4
1BronxCare Health System, Bronx, NY; 2Guru Gobind Singh Medical College, Faridkot, Punjab, India; 3Independent Researcher, Triolet, Pamplemousses, Mauritius; 4One Brooklyn Health System/Interfaith Medical Center Program, Brooklyn, NY

Introduction: While esophagogastroduodenoscopy (EGD) remains one of the first-line treatments for the management of acute upper gastrointestinal bleeding(UGIB), there is a paucity of data on potential racial disparities in the care and outcomes of patients in the United States. In this study, we aim to investigate the use of EGD for UGIB between Whites, Blacks, and Hispanics and their associated complications.

Methods: We queried data for adults (ages≥18 years) classified as Whites, Blacks, or Hispanics, admitted with a primary diagnosis of Upper GI bleeding with a procedural code for EGD based on ICD-10 codes from past studies. Patient and hospital characteristics and the odds of perforation, hemorrhage, aspiration, and sepsis were compared between the different racial cohorts.

Results: We initially found 866340 cases of UGIB between the three racial groups and 56.7% (366430 cases) of Whites, 57.9%(74170 cases) of Blacks, and 58.3%(51955 cases) of Hispanics (p< 0.01) required care via EGD (table1). Whites were older than Blacks and Hispanics, and the three groups were all primarily covered by Medicare, treated in Large bed-sized hospitals, and involved mostly urban teaching centers. Whites and Blacks were mostly in the Southern part of the US, while Hispanics were mostly in the Western part. Differences in the prevalence of multiple comorbidities were also observed, as Hispanics had a higher prevalence of cirrhosis, diabetes, and alcohol abuse. In comparison, Whites had a higher prevalence of hypertension, peripheral vascular disease, old myocardial infarction, lipid disorder, long term anticoagulant use, and Blacks had a higher prevalence of smoking, obesity, CKD, prior stroke, and drug abuse. Furthermore, Blacks reported the highest mean Charlson Comorbidity Index (CCI) score among the three cohorts. After adjusting for confounders and variables, compared to Whites, Blacks, and Hispanics reported lower odds of aspiration (aOR0.747, p< 0.01, aOR 0.811,p< 0.01 each) and death (aOR0.725, p< 0.01, aOR 0.761, p< 0.01, each). At the same time, a higher risk of septicemia was noted among Hispanics (vs. Whites, aOR 1.078, p=0.038).

Discussion: Our study showed higher use of EGD for UGIB among Blacks and Hispanics, who also reported lower odds of aspiration and death than Whites. Hispanics also demonstrated higher odds of septicemia (vs. Whites). This paves the way for further studies on racial disparities that can help bridge the gaps in access to care and system-level interventions.

Figure: Adjusted odds ratio of various complications among adults admitted for Upper GI bleed undergoing EGD in the United States between 2016-2020

Characteristics

White (n=366430) (%)

Black (n=76170) (%)

Hispanic (n=51955) (%)

p-value

Mean age(years)

68.93

62.26

61.59

< 0.01

Weekend admission

23.9

24.8

25.3

< 0.01

Female

47.1

44.6

38.4

< 0.01

Disposition of patients

Routine

Short-term Hospital

Another type of facility

Home Health care

Against medical advice

Died

 

64.6

1.6

17.3

13.9

1.2

1.5

 

68.1

1.1

14.7

13.3

1.6

1.1

 

74.1

1.3

10.6

11.0

1.8

1.2

< 0.01

Primary payer form

Medicare

Medicaid

Private

 

67.7

8.5

17.8

 

55.9

17.9

16.7

 

47.1

24.3

16.8

< 0.01

Median household income

0-25th percentile

26th to 50th percentile (median)

51st to 75th percentile

76th to 100th percentile

 

25.3

28.0

25.6

21.1

 

54.1

21.8

14.8

9.2

 

38.6

25.6

22.5

13.3

< 0.01

Bed size

Small

Medium

Large

 

20.8

31.3

48.0

 

18.9

30.4

50.7

 

19.0

33.8

47.2

< 0.01

Location/teaching status

Rural

Urban nonteaching

Urban teaching

 

9.2

25.2

65.5

 

5.3

17.6

77.1

 

2.2

25.5

72.4

< 0.01

Region of hospital

Northeast

Midwest

South

West

 

17.1

24.7

38.8

19.5

 

13.7

21.2

55.4

9.7

 

13.5

7.0

36.5

43.0

< 0.01

Cirrhosis

8.7

6.5

16.8

< 0.01

Diabetes

28.3

38.0

40.0

< 0.01

Hypertension

41.4

37.4

35.6

< 0.01

Peripheral vascular disease

6.2

5.4

4.3

< 0.01

Smoking

44.4

46.2

32.9

< 0.01

Obesity

14.4

14.9

14.1

< 0.01

CKD

23.3

35.8

24.9

< 0.01

Prior stroke

9.0

9.3

6.5

< 0.01

Old MI

8.6

6.9

6.1

< 0.01

Alcohol abuse

13.3

13.3

19.7

< 0.01

Drug abuse

3.1

6.1

4.8

< 0.01

Lipid disorder

43.5

36.5

34.5

< 0.01

Long term anticoagulant use

15.5

11.1

8.4

< 0.01

Mean CCI score

3.28

3.72

3.36

< 0.01

Mean Length of stay (days)

4.48

4.95

4.35

< 0.01

Complications and rate per 100,000 procedures

Perforation

Number of cases

100

25

15

0.71

Rate per 100,000 procedures

27

33

29

 

Bleeding/hematoma

Number of cases

225

65

40

0.04

Rate per 100,000 procedures

61

85

77

 

Aspiration

Number of cases

7800

1175

930

< 0.01

Rate per 100,000 procedures

2129

1543

1790

 

Septicemia

Number of cases

5945

1390

1060

< 0.01

Rate per 100,000 procedures

1622

1825

2040

 

Death

Number of cases

5410

865

645

< 0.01

Rate per 100,000 procedures

1476

1136

1241

 

Adjusted odds ratio of various complications

 

Lower

Upper

aOR

p-value

Perforation

White (reference)

Black

.979

2.533

1.575

.061

Hispanic

.538

1.731

.965

.904

Bleeding/hematoma

White (reference)

Black

.904

1.643

1.219

.195

Hispanic

.844

1.738

1.212

.298

Aspiration

White (reference)

Black

.700

.798

.747

< .001

Hispanic

.754

.874

.811

< .001

Septicemia

White (reference)

Black

.912

1.036

.972

.382

Hispanic

1.004

1.158

1.078

.038

Death

White (reference)

Black

.671

.782

.725

< .001

Hispanic

.697

.831

.761

< .001


Table: Table 1. Adults admitted for Upper GI bleed undergoing EGD in the United States between 2016-2020


Disclosures:
Harpreet Kaur indicated no relevant financial relationships.
Renuka Verma indicated no relevant financial relationships.
Kamleshun Ramphul indicated no relevant financial relationships.
Hemamalini Sakthivel indicated no relevant financial relationships.


Harpreet Kaur, MBBS1, Renuka Verma, MBBS2, Kamleshun Ramphul, MD3, Hemamalini Sakthivel, MD4. P0423 - Use of Esophagogastroduodenoscopy for Upper Gastrointestinal Bleeding Among Whites, Blacks, and Hispanics and Associated Disparities, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.