P2448 - Gastrointestinal Physician Density (GIPD) in the USA: The Critical Shortage of Gastroenterologists and the Impact on Upper Gastrointestinal Bleeding Mortality Across All 50 States

Abuoma Cherry. Ekpendu, DO, Muhammad Sohaib Asghar, MBBS, MD, Pankajkumar Patel, MD, Chad K. Brands, MD
AdventHealth, Sebring, FL

Introduction: Upper gastrointestinal bleeding (UGIB) continues to be a significant burden on the national healthcare system. Despite the availability of innovative treatments, trends in UGIB have been on the rise. Few studies exist that examine the mortality of UGIB in the United States over a prolonged period. Additionally, geographical patterns of disease-associated mortality for UGIB have never been explored in-depth. Therefore, we studied the trends of UGIB mortality in the United States (US) and examined the impact of primary care provider density (PCPD) and gastrointestinal physician density (GIPD) at state and county levels.

Methods: The ICD-10 codes were selected first on the Center for Disease Control and Prevention - Wide-ranging Online Data for Epidemiologic Research (CDC-WONDER) database for UGIB mortality and all patients were included without any age restrictions. Crude and Age-Adjusted Mortality Rates (AAMRs) were abstracted from multiple cause of death files from 1999-2023 using the 2000 US Census as the standard population. Correlation and linear regression analyses were then performed to determine area health resource files (AHRF) study variables including PCPD and GIPD.

Results: The overall crude mortality rate (CMR) over the study period (1999-2023) for UGIB was 12.1 per 100,000 and the AAMR was 11.0 per 100,000 among the US population. Overall, mortality trends increased during the period 2018-2021 (Annual Percent Change [APC]: +9.05) and decreased from 2021-2023 (APC: -7.93). CMR was highest in older age groups, American Indians, Native Alaskans, and in rural communities. Males have higher AAMR than females. States in the top (90th) percentile for CMR overall from 1999-2023 included: West Virginia, Rhode Island, Vermont, South Dakota, New Mexico, and Wyoming. According to Area Health Resource Files (AHRF), GIPD in most of the 50 states is significantly correlated with CMR (rho= -0.214, p< 0.001), with lower quartiles of GIPD being associated with the highest UGIB mortality.

Discussion: GIPD rather than PCPD was significantly associated with high mortality for UGIB in most United States counties. Addressing the rising mortality trends of UGIB will require increasing the number of gastroenterologists in the US by creating additional new fellowship programs in gastrointestinal diseases and by expanding the size of existing fellowship programs in graduate medical education. Additionally, enhancing resources like endoscopy suites will be crucial in effectively combating this condition.



Disclosures:


Abuoma Cherry. Ekpendu, DO, Muhammad Sohaib Asghar, MBBS, MD, Pankajkumar Patel, MD, Chad K. Brands, MD. P2448 - Gastrointestinal Physician Density (GIPD) in the USA: The Critical Shortage of Gastroenterologists and the Impact on Upper Gastrointestinal Bleeding Mortality Across All 50 States, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.