Racial Disparities in Upper Gastrointestinal Hemorrhage Treatment

Area of Science:

• Gastroenterology
• Health Services Research
• Health Disparities

Background:

• Acute upper gastrointestinal (GI) hemorrhage is a critical condition requiring timely and effective treatment.
• Understanding demographic predictors for treatment outcomes is crucial for equitable healthcare delivery.
• Race and socioeconomic status are key factors to examine in relation to advanced treatment, mortality, and length of stay (LOS).

Purpose of the Study:

• To identify demographic predictors, specifically race and socioeconomic status, associated with advanced treatment modality, mortality, and length of stay (LOS) in patients with upper GI hemorrhage.
• To investigate racial disparities in treatment and outcomes for upper GI hemorrhage.
• To analyze the impact of socioeconomic status on upper GI hemorrhage management and patient outcomes.

Main Methods:

• Utilized the National Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP) for hospitalizations between 2016 and 2021.
• Categorized treatments into interventional radiology (IR) and non-IR (endoscopic) modalities.
• Performed statistical analyses, including calculation of odds ratios and confidence intervals, to assess mortality and mean LOS, while controlling for confounding factors.

Main Results:

• No significant differences in the likelihood of receiving interventional radiology (IR) procedures or in mortality rates were observed between White patients and Non-Hispanic (NH) Black or Hispanic patients.
• NH Black patients exhibited significantly longer LOS (12.61 days) compared to White patients (9.57 days), a disparity that persisted across various matched conditions, including socioeconomic status and comorbidities.
• These length of stay differences were not observed under matching conditions in the post-COVID-19 era.

Conclusions:

• The study identified significant racial disparities in LOS for upper GI hemorrhage, particularly for NH Black patients, without corresponding differences in advanced treatment utilization or mortality.
• While confounders influenced LOS in non-IR treatments, NH Black patients consistently experienced longer LOS than White patients following IR treatment.
• Findings highlight the need to address systemic factors contributing to prolonged hospital stays in specific demographic groups following acute upper GI hemorrhage.