B0278 - The Association of Patient Demographics and Socioeconomic Status With Advanced Neoplasia in Endoscopic Mucosal Resection

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

YH

Yassmin Hegazy, MD

University of Alabama at Birmingham
Birmingham, AL

Yassmin Hegazy, MD¹, Rebecca Sullivan, MD¹, Ashutosh Tamhane, MD, PhD¹, Bijal Vashi, MS², Lonnie Hannon, PhD², Ariann Nassel, MA², Sergio A. Sánchez-Luna, MD², Ali M. Ahmed, MD¹, Kondal R. Kyanam Kabir Baig, MD¹, Shajan Peter, MD¹, Ramzi Mulki, MD¹
¹University of Alabama at Birmingham, Birmingham, AL; ²University of Alabama Birmingham, Birmingham, AL

Introduction: Endoscopic Mucosal Resection (EMR) is a minimally invasive procedure that allows for the removal of pre-cancerous and cancerous lesions. In recent years, colorectal cancer mortality in the United States (U.S.) southern states including Alabama have exceeded national levels with minority and under-represented populations having a higher risk of advanced neoplasia on screening colonoscopies. Socioeconomic status (SES) can affect access to EMR procedures. Our study examines the factors associated with advanced neoplasia following EMR.

Methods: We performed a retrospective review study examining patients who had EMR at our institution between March 2017 to March 2022. Patient demographics, procedural data, and census data were collected. Census data included median household income and home value which were calculated in U.S. dollars, disability status, occupation, and education attainment which were joined by zipcode to the primary data. Patients were divided into two groups, patients with advanced and non-advanced neoplasia. Advanced neoplasia was defined according to the recent U.S. multi-society task force on colorectal cancer.

Results: Our cohort consisted of 450 patients divided into two groups: 79.3% (N=357) with advanced neoplasia and 20.7% (N=93) with non-advanced neoplasia with baseline characteristics reported in Table 1. Compared to patients with non-advanced neoplasia, patients with advanced neoplasia were older (64.5 vs 60.3 years) and male (86.3%). Patients with advanced neoplasia had a higher percentage identifying as African-American or non-white (88.9%, 66.7% respectively), were overweight (85.4%), and were current alcohol users (74.5%). Census data indicated that patients with advanced neoplasia had a lower median household income ($49,374 vs $59,740) compared to patients with non-advanced neoplasia respectively.

Discussion: Our study demonstrated that patients with advanced neoplasia were more likely to be older males, overweight, and with a lower income compared to patients with non-advanced neoplasia. Furthermore, patients with advanced neoplasia were more likely to be among minority populations. Within the limitations of this small retrospective study, our findings shed light on important factors associated with advanced neoplasia potentially allowing us to personalize care. Larger prospective studies are needed to confirm our findings.

Category	Overall	Pathology
	N=450	Advanced Neoplasia (N=357), 79.3%	Non-advanced Neoplasia (N=93), 20.7%	p-value
Age (years), mean (SD)	63.6 (10.3)	64.5 (10.1)	60.3 (10.4)	0.001^*
Sex: Male	227 (50.4%)	196 (86.3%)	31 (13.7%)	< 0.001^*
Female	223 (49.6%)	161 (72.2%)	62 (27.8%)	< 0.001^*
Race: White	297 (66.9%)	224 (75.4%)	73 (24.6%)	0.003^*
African-American	135 (30.4%)	120 (88.9%)	15 (11.1%)
Other+	12 (2.7%)	8 (66.7%)	4 (33.3%)
BMI⁺⁺: Normal	111 (25.6%)	88 (79.3%)	23 (20.7%)	0.047^*
Overweight	137 (31.6%)	117 (85.4%)	20 (14.6%)
Obese	185 (42.7%)	137 (74.1%)	48 (25.9%)
ASA classification: 1	3 (0.7%)	2 (66.7%)	1 (33.3%)	0.642
2	266 (59.2%)	207 (77.8%)	59 (22.2%)
3	177 (39.4%)	145 (81.9%)	32 (18.1%)
4	3 (0.7%)	2 (66.7%)	1 (33.3%)
Smoking: Current	103 (22.9%)	89 (86.4%)	14 (13.6%)	0.127
Former	128 (28.4%)	96 (75.0%)	32 (25.0%)
Never	217 (48.2%)	171 (78.8%)	46 (21.2%)
Alcohol: Current	208 (46.2%)	155 (74.5%)	53 (25.5%)	0.006^*
Former	31 (6.9%)	21 (67.7%)	10 (32.3%)
Never	209 (46.4%)	180 (86.1%)	29 (13.9%)
Drugs: Current	16 (3.6%)	14 (87.5%)	2 (12.5%)	0.327
Former	20 (4.4%)	18 (90.0%)	2 (10.0%)
Never	396 (88.0%)	309 (78.0%)	87 (22.0%).

Table: Table 1: Baseline Characteristics of Patients with Advanced and Non-Advanced Neoplasia following EMR
* Statistical significance: p-value<0.05
+Other Race includes: Hispanic, Asian, other
++Normal: BMI between 18.5 and 24.9, Overweight: BMI between 25.0 and 29.9, Obese: more than 30.0

Disclosures:

Yassmin Hegazy indicated no relevant financial relationships.

Rebecca Sullivan indicated no relevant financial relationships.

Ashutosh Tamhane indicated no relevant financial relationships.

Bijal Vashi indicated no relevant financial relationships.

Lonnie Hannon indicated no relevant financial relationships.

Ariann Nassel indicated no relevant financial relationships.

Sergio Sánchez-Luna indicated no relevant financial relationships.

Ali Ahmed indicated no relevant financial relationships.

Kondal Kyanam Kabir Baig: Ambu – Consultant. Ambu – Grant/Research Support. Olympus – Grant/Research Support.

Shajan Peter indicated no relevant financial relationships.

Ramzi Mulki indicated no relevant financial relationships.

Yassmin Hegazy, MD¹, Rebecca Sullivan, MD¹, Ashutosh Tamhane, MD, PhD¹, Bijal Vashi, MS², Lonnie Hannon, PhD², Ariann Nassel, MA², Sergio A. Sánchez-Luna, MD², Ali M. Ahmed, MD¹, Kondal R. Kyanam Kabir Baig, MD¹, Shajan Peter, MD¹, Ramzi Mulki, MD¹. B0278 - The Association of Patient Demographics and Socioeconomic Status With Advanced Neoplasia in Endoscopic Mucosal Resection, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.