P0589 - Racial Disparities in Patients Hospitalized With Acute Lower GI Bleeding: A Population-Based Study

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Rabia Rizwan, MD

Yale University School of Medicine
New Haven, CT

Rabia Rizwan, MD¹, AbdelKader Chaar, MD¹, Ahmad Nawaz, MD¹, Shanti Patel, MD¹, Paul Feuerstadt, MD, FACG²
¹Yale University School of Medicine, New Haven, CT; ²PACT Gastroenterology Center and Yale School of Medicine, Hamden, CT

Introduction: Little is known about the potential role of race and ethnicity affecting outcomes and hospital course for hospitalizations due to lower gastrointestinal bleeding (LGIB). This study aimed to investigate whether racial disparities exist in risk-adjusted hospital mortality and clinical course for LGIB.

Methods: We conducted a retrospective cohort study using the 2019 National Inpatient Sample (NIS) of hospitalized patients with primary discharge diagnoses LGIB. Self-reported race/ethnicity was categorized into three groups: White, Black, and others (including Hispanic, Asian or Pacific Islander, Native American, and Others). “Others” were excluded from this study. We used multivariate regression after adjusting for demographics and Charlson co-morbidity index (CCI) to compare our outcomes of interest, including mortality, colectomy, length of stay, and hospitalization charges. Secondary outcomes focused on clinical course, such as blood transfusion requirement, hypovolemic shock, intensive care unit (ICU) stay and colonoscopy performed.

Results: A total of 114,670 hospitalizations met the criteria of LGIB. Of these, 75,150 pts White and 22,925 were Black. The Black population had a higher percentage of women (59.45% vs 49.99%, p< 0.001). Even though the blacks were younger (mean age 69.39 vs 74.38 in Whites, p< 0.001), they were sicker with more chronic medical co-morbidities (CCI 2.39 vs 2.57, p< 0.001) and more severe hospital course, requiring more blood transfusions (30.03% vs 25.15%, p=< 0.001) and ICU stay (2.07% vs 1.33%, p=0.0009) compared with the White population. Prior to confounding for other variables, there were no statistical differences in mortality or colectomy between those who were black and whites. Multivariate logistic regression also showed no differences in adjusted inpatient mortality and colectomy. However, the Black population underwent more blood transfusions [OR 1.3 (1.17-1.44), p< 0.001], ICU stay [OR 1.53 (1.14-2.03), p=0.004], and colonoscopy [OR 1.17 (1.08-1.26), p< 0.001] but they were less likely to have early colonoscopy (colonoscopy on day 1 or 2) [OR 0.89 (0.80-0.99), p=0.011].

Discussion: In this study, race did not impact mortality and colectomy rates for LGIB. However, Black patients appear to experience a more severe hospital course requiring more blood transfusions and ICU stays. Understanding the increased severity of hospital course in the Black population can be important when considering how aggressive one should be in treating these patients

Figure: Forrest plot showing odds ratio (OR) of outcomes adjusted for age, gender, median household income for zip code, primary insurance, and Charles co-morbidity index in Blacks with White as a reference.
(ICU = Intensive Care Unit; OR =Odds Ratio)

Parameter	Whites (n=75,150)	Blacks (n= 22,925)	*p-value*
Demographics
*Female, %*	49.99	59.45	< 0.001
*Age (years), mean ± SD*	74.38 ± 13.16	69.39 ± 14.28	< 0.001
*Age >=65 years, %*	80.39	66.53	< 0.001
*Median household income, %*			< 0.001
*0-25th percentile*	23.07	50.67
*26th-50th percentile*	25.89	19.85
*51st-75th percentile*	26.76	18.03
*76th-100th percentile*	24.27	11.44
*Primary Payer, %*			< 0.001
*Medicare*	78.52	68.14
*Medicaid*	4.12	9.09
*Private insurance*	13.72	16.86
*Self-pay*	1.63	3.36
*No charge*	0.17	0.39
*Other*	1.84	2.16
*Region of the hospital, %*			< 0.001
*Northeast*	22.06	17.95
*Midwest*	24.51	19.19
*South*	38.60	55.56
*West*	14.83	7.30
*Bed Size of the Hospital, %*			0.0311
*Small*	23.85	20.37
*Medium*	30.63	30.38
*Large*	45.52	49.26
*Location of the Hospital, %*			< 0.001
*Rural*	9.38	5.26
*Urban*	90.62	94.74
*Location of the Hospital, %*			< 0.001
*Rural*	9.38	5.26
*Urban nonteaching*	21.15	14.41
*Urban teaching*	69.47	80.33
*Charlson co-morbidity index, mean ± SD*	2.39 ± 2.21	2.57 ± 2.32	< 0.001
Colonoscopy
*Performed during admission, %*	52.95	56.15	0.0002
*Early Colonoscopy (performed during day 0 or 1), %*	41.90	36.67	0.0001
Clinical Course
*Blood Transfusion Requirement %*	25.15	30.03	< 0.001
*Hypovolemia Shock, %*	1.60	1.70	0.6402
*Vasopressors, %*	0.47	0.65	0.1933
*Endo tracheal Intubation, %*	1.01	1.61	0.0013
*ICU Admission, %*	1.33	2.07	0.0009
*AKI, %*	18.45	19.41	0.1653
Outcomes
*Inpatient mortality, %*	1.06	0.89	0.3418
*Colectomy, %*	1.42	1.74	0.1215
*Length of stay, mean ± SD*	3.92 ± 3.73	4.43 ± 3.98	< 0.001
*Total charges, mean*	42772.93	48820.74	< 0.001
*Disposition of patients, %*			< 0.001
*Routine*	66.10	69.06
*Short-term hospital*	1.72	1.4
*Skilled nursing facility*	14.97	11.32
*Home health care*	15.08	15.86
*Against medical advice*	1.06	1.44
*Died*	1.06	0.89

Table: Comparison of baseline demographics, clinical course colonoscopy performed, and unadjusted outcomes between White and Black population

Disclosures:

Rabia Rizwan indicated no relevant financial relationships.

AbdelKader Chaar indicated no relevant financial relationships.

Ahmad Nawaz indicated no relevant financial relationships.

Shanti Patel indicated no relevant financial relationships.

Paul Feuerstadt: Ferring/Rebiotix, Inc. – Advisory Committee/Board Member, Consultant, Speakers Bureau. Merck & Co. – Consultant, Speakers Bureau. Seres Therapeutics – Advisory Committee/Board Member, Consultant, Speakers Bureau. Takeda Pharmaceuticals – Advisory Committee/Board Member, Consultant, Speakers Bureau.

Rabia Rizwan, MD¹, AbdelKader Chaar, MD¹, Ahmad Nawaz, MD¹, Shanti Patel, MD¹, Paul Feuerstadt, MD, FACG². P0589 - Racial Disparities in Patients Hospitalized With Acute Lower GI Bleeding: A Population-Based Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.