P0657 - Social Determinants of Therapeutic Endoscopy and Procedure Time in Patients With Acute Upper Gastrointestinal Bleeding

Adedeji Adenusi, MD, MPH¹, Emeka Obi, MD, MPH², Olamide Asifat, MD, MPH³, Hezborn Magacha, MD, MPH⁴, Adebolanle Ayinde, MD, MPH⁵, Madhav Changela, MD^1
1One Brooklyn Health-Interfaith Medical Center, Brooklyn, NY; ²East Tennessee State University, Johnson City, TN; ³Georgia Southern University, Statesboro, GA; ⁴East Tennessee State University Quillen College of Medicine, Johnson City, TN; ⁵CHRISTUS Health | Texas A&M School of Medicine, Longview, TX

Introduction: Acute upper gastrointestinal bleeding (UGIB) is a major gastrointestinal emergency, referred to as the blood loss in areas of GI tract above the ligament of Treitz. It is a common cause of hospitalizations in the US, accounting for more than 50% of persons admitted for GI bleeding with an associated 2-10% of deaths. Studies have highlighted racial disparities in endoscopy, but little is known about social predictors of therapeutic endoscopy and procedure time.

Methods: We used the National Inpatient Sample data from 2016-2020 for this retrospective study. We sampled patients with a primary diagnosis of UGIB and assessed for endoscopic treatment, weekend admission, socio-demographic, and hospital characteristics. We conducted a chi-square test of categorical variables, descriptive analysis, bivariate and multivariate logistic regressions to identify the social predictors of endoscopic therapy and procedure time.

Results: A total of 135,795 (weighted frequency) adults with a primary diagnosis of acute UGIB were included in this study of which 22.15% had therapeutic endoscopic treatment. More than two-thirds of endoscopies performed were in urban teaching hospitals, on weekdays, and among white elderly patients on Medicare. The study revealed that the odd of endoscopy treatment increases with age, highest in patients aged >=65 years (aOR= 5.35, CI:3.33-8.62, p< .0001), in hospitals located in the Midwest (1.29, 1.16-1.14, p< .0001) or Northeast regions (1.19, 1.05-1.33, p = 0.005), with lower odds in patients admitted on weekends (0.90, 0.84-0.97, p=0.004), in rural hospitals (0.46, 0.38-0.56, p< .0001) or urban non-teaching (0.84, 0.76-0.93, p=0.0009), small or medium bed facilities (0.78, 0.71-0.86, p< .0001), western region hospitals (0.89, 0.79-0.99, p=0.0352). Based on procedure timing, patients admitted on weekends (1.36, 1.182-1.560), p< .0001) are more likely to have an endoscopy within 24 hours from admission. While those admitted in small or medium bed facilities, non-teaching hospitals, western region hospitals and males are less likely to get an endoscopy within 24 hours from admission.

Discussion: This study identified key social factors and hospital characteristics that impact endoscopic treatment. This will further raise awareness about disparities in standard endoscopy care and promote advocacy for better access to endoscopic treatments in underserved areas. Further research on methods to improving access to endoscopy is essential.


Disclosures:


Adedeji Adenusi, MD, MPH¹, Emeka Obi, MD, MPH², Olamide Asifat, MD, MPH³, Hezborn Magacha, MD, MPH⁴, Adebolanle Ayinde, MD, MPH⁵, Madhav Changela, MD¹. P0657 - Social Determinants of Therapeutic Endoscopy and Procedure Time in Patients With Acute Upper Gastrointestinal Bleeding, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.