Demographic Differences in Diagnosis of Eosinophilic Esophagitis: A Retrospective Analysis

To investigate trends in coded eosinophilic esophagitis (EoE) diagnosis within the TriNetX healthcare population and the association between food impaction (FI) and subsequent EoE diagnosis across demographic groups.

A retrospective review (2016-2024) was conducted in the TriNetX US Network. Platform-derived annual incidence of coded EoE diagnosis (ICD-10 K20.0) in patients < 21 years was assessed and stratified by sex, race, and ethnicity. Patients presenting with FI (ICD-10 T18.12) were identified, and demographic characteristics of those with and without a subsequent coded EoE diagnosis were compared. The FI analysis did not evaluate endoscopy, biopsy, histology, referral, or other elements of the diagnostic process.

A total of 42,519 incident coded EoE diagnoses were identified, with TriNetX-derived diagnosis incidence increasing from 27.8 to 65.8 per 100,000 persons between 2016 and 2024 (136.6% rise). In 2024, males had nearly double the diagnosis rate of females (88.1 vs. 44.2 per 100,000). White patients had the highest diagnosis rate (84.7), compared with Black (31.5), Asian (37.7), and American Indian (62.2) patients. Non-Hispanic patients had higher rates than Hispanic patients (73.3 vs. 30.0). Among 6215 patients presenting with FI (mean age 11.9 ± 6.3 years), 1849 (29.8%) had a subsequent coded EoE diagnosis (mean age 14.7 ± 4.3). Females had lower unadjusted odds than males (OR = 0.5, 95% CI: 0.4-0.5, p < 0.001). Black (OR = 0.3, 95% CI: 0.2-0.4) and Asian (OR = 0.4, 95% CI: 0.2-0.6) patients had lower unadjusted odds than White patients (p < 0.001).

Within the TriNetX healthcare population, coded pediatric EoE diagnoses increased over time and differed by sex, race, and ethnicity. Following FI, the frequency of subsequent coded EoE diagnosis also differed across demographic groups; these descriptive findings do not establish differences in underlying disease prevalence or diagnostic care.