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

Harpreet Kaur, MBBS¹, Renuka Verma, MBBS², Kamleshun Ramphul, MD³, Hemamalini Sakthivel, MD^4
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.




Disclosures:


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.