Racial Disparities in Adherence to Quality Indicators in Barrett's Esophagus: An Analysis Using the GIQuIC National Benchmarking Registry

Abstract

INTRODUCTION: Racial disparities in outcomes in esophageal adenocarcinoma are well established. Using a nationwide registry, we aimed to compare clinical and endoscopic characteristics of blacks and whites with Barrett's esophagus (BE) and adherence to defined quality indicators. METHODS: We analyzed data from the Gastrointestinal Quality Improvement Consortium Registry between January 2012 and December 2019. Patients who underwent esophagogastroduodenoscopy with an indication of BE screening or surveillance, or an endoscopic finding of BE, were included. Adherence to recommended endoscopic surveillance intervals of 3–5 years for nondysplastic BE and adherence to Seattle biopsy protocol were assessed. Multivariate logistic regression was conducted to assess variables associated with adherence. RESULTS: A total of 100,848 esophagogastroduodenoscopies in 84,789 patients met inclusion criteria (blacks—3,957 and whites—96,891). Blacks were less likely to have histologically confirmed BE (34.3% vs 51.7%, P < 0.01), had shorter BE lengths (1.61 vs 2.35 cm, P < 0.01), and were less likely to have any dysplasia (4.3% vs 7.1%, P < 0.01). Although whites were predominantly male (62.2%), about half of blacks with BE were female (53.0%). Blacks with nondysplastic BE were less likely to be recommended appropriate surveillance intervals (OR 0.78; 95% CI 0.68–0.89). Adherence rates to the Seattle protocol were modestly higher among blacks overall (OR 1.12, 95% CI 1.04–1.20), although significantly lower among blacks with BE segments >6 cm. DISCUSSION: The use of sex as a risk factor for BE screening may be inappropriate among blacks. Fewer blacks were recommended appropriate surveillance intervals, and blacks with longer segment BE were less likely to undergo Seattle biopsy protocol.

Disparities in Emergency Department Waiting Times for Acute Gastrointestinal Bleeding

“…Our results showed that AA patients had to wait almost 20 minutes longer than NHW for a medical provider evaluation. This finding is comparable with prior studies which reported racial disparities in receiving emergency care and access to health care in patients with gastrointestinal disorders 6,9,39–41 . It has been hypothesized that socioeconomic conditions could be 1 of the potential drivers of this discrepancy 42,43 .…”

Management of nondysplastic Barrett’s esophagus: When to survey? When to ablate?

“…Racial disparities also exist and studies have shown that black patients with NDBE were less likely to be recommended appropriate surveillance intervals (OR: 0.78; 95% CI: 0.68–0.89). 22 Adherence rates to the Seattle protocol found in this study were modestly higher among black patients overall (OR: 1.12, 95% CI: 1.04–1.20), although significantly lower among blacks with BE segments > 6 cm.…”

Wide Variability in Dysplasia Detection Rate and Adherence to Seattle Protocol and Surveillance Recommendations in Barrett's Esophagus: A Population-Based Analysis Using the GIQuIC National Quality Benchmarking Registry

“…Possible explanations for this variability include lack of knowledge, personal disagreement with guidelines, or financial incentives. Patient factors such as racial differences may also contribute to variable rates because previous research has shown that Blacks are less likely than Whites to have appropriate surveillance intervals (10).…”