Original article—alimentary tract
Racial and Ethnic Disparities in the Prevalence of Barrett’s Esophagus Among Patients Who Undergo Upper Endoscopy

https://doi.org/10.1016/j.cgh.2007.10.006Get rights and content

Background & Aims: The incidence of esophageal adenocarcinoma (EAC) in blacks and Hispanics is well-described, but racial differences in the risk of Barrett’s esophagus (BE) have not been directly studied. It is important to determine whether race and ethnicity can be identified as risk factors for the development of metaplasia, neoplastic progression, or both. Methods: We performed a single center retrospective cross-sectional analysis of all patients who underwent upper endoscopy during a 1-year period. Patients with a prior endoscopy within 5 years or known BE or EAC were excluded. Suspected cases of BE were confirmed by pathology report. Results: A total of 2100 patients met inclusion criteria. Whites (37.7%), blacks (11.8%), and Hispanics (22.2%) comprised the majority. Whites had a significantly higher prevalence of BE than Hispanics (6.1% vs 1.7%, P = .0002) and blacks (6.1% vs 1.6%, P = .004). In multivariable analysis, factors associated with decreased risk of BE were black race (odds ratio [OR], 0.34; 95% confidence interval [CI], 0.12–0.97) and Hispanic ethnicity (OR, 0.38; 95% CI, 0.18–0.84). Male sex (OR, 1.86; 95% CI, 1.20–2.87), reflux symptoms (OR, 2.87; 95% CI, 1.84–4.45), hiatal hernia (OR, 3.53; 95% CI, 2.17–5.72), and older age were associated with increased risk of BE. Conclusions: Among patients who undergo upper endoscopy, blacks and Hispanics have a significantly lower prevalence of BE compared with whites. These differences in prevalence are comparable to the relative incidence rates observed with EAC, implying that progression from BE to adenocarcinoma does not vary by race/ethnicity. Reasons for lower rates of BE in Hispanics and blacks need further investigation.

Section snippets

Methods

All upper endoscopies performed at the CUMC Adult Endoscopy Suite for the 12-month period April 1, 2005–March 31, 2006 were reviewed. Data were extracted from CUMC’s electronic medical records system. The following data were recorded: patient age, sex, race/ethnicity, indication for upper endoscopy, and endoscopic findings, including the presence and length of BE and the presence of a hiatal hernia. Pathology reports were reviewed for all suspected BE cases, and a patient was considered to have

Results

A total of 3690 patients underwent upper endoscopy between April 2005 and March 2006. Among these, 1559 had an upper endoscopy within the previous 5 years, and another 31 were excluded because the indication for endoscopy was suggestive of a prior known history of BE or EAC. Of the remaining 2100 patients, the mean age was 55.8 years (standard deviation, 17.6), and 39.8% were male (Table 1). Compared with whites, Hispanics were younger (55.3 vs 58.7 years, P = .0009) and less likely to be male

Discussion

In this hospital-based cross-sectional study of the prevalence of BE among minorities, both Hispanics and blacks were found to have a significantly lower prevalence of BE as compared with whites. This study was specifically aimed to address the prevalence of BE in minority populations and was sufficiently powered to do so.

The issue of racial and ethnic discrepancies in the prevalence of BE has been addressed only in 2 prior published studies. A retrospective cross-sectional study from the

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Supported in part by a R25 grant from the NCI (CA94061) (J.A.A.) and a K05 Award from the NCI (CA89155) (A.I.N.).

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