P2407 - Racial and Ethnic Disparity of Esophageal Biopsy in Patients With Dysphagia

Amr Arar, MD¹, Frank I. Scott, MD, MSCE², Kelli DeLay, MD², Paul Menard-Katcher, MD^2
1University of Colorado Anschutz Medical Campus, Denver, CO; ²University of Colorado Anschutz Medical Campus, Aurora, CO

Introduction: Eosinophilic Esophagitis (EoE) is thought to be more prevalent in patients who self-identify as white. However, the prevalence of EoE may be underreported in non-white populations. We aimed to investigate rates of esophageal biopsies in patients presenting with dysphagia, stratified by self-identified race and ethnicity, to better understand how clinicians may differentially evaluate for EoE.

Methods: We performed a retrospective, multicenter study comparing the rate of esophageal biopsy among patients with dysphagia who underwent endoscopy at a university-based academic hospital and a safety-net hospital from July to December 2020. Data collected included age, self-identified race/ethnicity, gender, diagnosis of EoE, esophageal endoscopic findings, esophageal biopsies obtained, and indication for esophageal biopsy. Chi square analysis was conducted comparing the indication for esophageal biopsy between races and frequency of endoscopic features seen in EoE (longitudinal furrows, concentric rings, mucosal edema, white exudates). A multivariable logistic regression analysis was performed in order to assess the association between biopsy rates and race/ethnicity, adjusting for age, hospital, and gender.

Results: 802 charts were analyzed (628 from the university-based hospital; 174 from the safety-net hospital). The rate of esophageal biopsy at the university hospital and the safety net hospital was 71.5% and 47.1% respectively (p < 0.001). There were 72 subjects (11.5%) identified with EoE at the university hospital compared with 8 individuals (4.6%) at the safety-net hospital (p = 0.007). Non-Hispanic White subjects were biopsied 71.3% of the time, compared to Black and Latinx subjects who were biopsied 54.6% and 51.9% of the time respectively (p < 0.001). After adjusting for age, gender, and hospital, Latinx patients were 40% less likely to be biopsied (OR 0.60, 95%CI 0.39-0.93) and Black individuals were 45% less likely to be biopsied (OR 0.55, 95%CI 0.33-0.92) when compared to Non-Hispanic White individuals.

Discussion: The rate of esophageal biopsy was lower in self-identified Black and Latinx patients presenting with dysphagia compared to Non-Hispanic White patients. The prevalence of EoE may be underestimated in minority populations due to variability of endoscopic practices between hospitals, differences in endoscopic findings between races, or potential pre-conceived provider bias of the demographic historically associated with EoE patients.



Disclosures:


Amr Arar, MD¹, Frank I. Scott, MD, MSCE², Kelli DeLay, MD², Paul Menard-Katcher, MD². P2407 - Racial and Ethnic Disparity of Esophageal Biopsy in Patients With Dysphagia, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.