Prognostic impact of deprivation on esophagogastroduodenoscopy outcome

Abstract

Introduction: Socio-Economic Deprivation has long been associated with many gastrointestinal diseases yet its influence on esophago-gastro-duodenoscopy (EGD) diagnosis has not been evaluated. The aim of this study was to investigate the influence of deprivation on outcomes of EGD irrespective of referral reason. Method: Two-thousand consecutive patients presenting to four Health Boards in Wales from June 2019 were studied retrospectively with deprivation scores calculated using the Wales Indices of Multiple Deprivation (WIMD). Patients were sub-classified into quintiles for analysis (Q1 most, Q5 least Deprived). Results: Inhabitants of the most deprived areas were more likely to be diagnosed with Peptic Ulcer (Q1 7.9%, Q5 4.7%; OR 0.498, p=0.018), Severe Esophagitis (LA4, Q1 2.7% v Q5 0%, OR 0.089, p=0.002), Helicobacter Pylori infection (Q1 5.4%, Q5 1.7%; OR 0.284, p=0.002), but less likely to be diagnosed with Barrett’s Eesophagus (Q1 6.3% v Q5 12.3%, OR 2.146, p=0.004) than those from least deprived areas. New cancer diagnoses numbered 53 and were proportionately higher after Urgent Suspected Cancer (USC, n=35, 4.6%) than routine referral (n=3, 0.6%, p<0.001). Deprivation was associated with more advanced staged cancer (stage III Q1 16.7% v Q5 5.6%, OR 0.997, p=0.006: stage IV Q1 16.7% v Q2 38.9% v Q5 22.2%, OR 0.998, p=0.049). Conclusion: Deprivation was associated with two-fold more peptic ulcer disease, three-fold more Helicobacter Pylori infection, and 12-fold more severe esophagitis, and more advanced cancer stage.