Healthcare Disparities and Upper Gastrointestinal Bleeding: Exploring the Linkages

Abstract

Introduction Upper gastrointestinal bleeding (UGIB) refers to blood loss from a gastrointestinal (GI) source proximal or above the ligament of Treitz. Health equity means giving everyone an equal chance to achieve optimal health by addressing injustices, overcoming barriers, and eliminating health disparities. Healthcare providers must analyze racial and ethnic disparities in UGIB management to ensure all patients receive equal care. Identifying risk factors in specific populations leads to tailored interventions that improve outcomes. Our study aims to examine trends and identify disparities in upper gastrointestinal bleeding across races and ethnicities to promote health equity. Methods Retrospective data on upper gastrointestinal bleeding from June 2009 to June 2022 were collected and categorized into five groups based on race. The baseline characteristics of each group were matched to ensure equitable comparison. A joinpoint regression model was used to compare incidence trends, identifying potential healthcare disparities for different racial/ethnic groups over time. Patients aged 18-75 who suffered from upper gastrointestinal bleeding at Nassau University Medical Center in New York from 2010 to 2021 were selected, excluding those with incomplete baseline comorbidity information. Results This study examined 5103 cases of upper gastrointestinal bleeding, with 41.9% female. The cohort was diverse, with 29.4% African American, 15.6% Hispanic, 45.3% White, 6.8% Asian, and 2.9% of other races. Data were split into two groups; 49.9% occurred between 2009 and 2015 and 50.1% between 2016 and 2022. Findings showed increased UGIB among Hispanics and decreased bleeding among Asians during 2016-2021 compared to 2009-2015. However, no significant difference was found for African Americans, Whites, and other races. In addition, Hispanics had a rise in the annual percentage change (APC) rate, whereas Asians had a decrease. Conclusion Our study examined trends in upper gastrointestinal bleeding and potential healthcare disparities across races and ethnicities. Our findings highlight an increased incidence of UGIB in Hispanics and a decreased incidence in Asians. Additionally, we identified a significant increase in the annual percentage change rate in Hispanics and a decrease in Asians over time. Our study underscores the importance of identifying and addressing disparities in UGIB management to promote health equity. Future research can build on these findings to develop tailored interventions that improve patient outcomes.

Racial Differences in Non-variceal Upper Gastrointestinal (GI) Bleeding: A Nationwide Study

“…For example, studies have shown that African Americans have worse outcomes after trauma [4], Asians represent the minority with the most admissions for acute cholangitis [5], and Latinxs and Native Americans have lower odds of undergoing esophagogastroduodenoscopy (EGD) for upper GI bleeding in rural hospitals [6]. Despite an increasing interest in racial differences in upper GI bleeding [7][8][9], the literature is limited on how race affects the etiologies and outcomes of non-variceal upper GI bleeding (NVUGIB). Our study aimed to elucidate differences in the etiologies of non-variceal upper GI bleeding among various racial groups and determine if there are any differences in outcomes such as in-hospital mortality, hospital length of stay (HLOS), admission to the intensive care unit (ICU), and total hospital charges.…”