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GERD is a common medical condition affecting up to 28% of the US general population. GERD is a primary risk factor of Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC). BE is twice more common, and EAC is 4 times more common, in males compared to females. Therefore, males with GERD are at increased risk of BE and would be expected to be more likely to receive an upper endoscopy (EGD) compared to females with the same risk factors. We aimed to investigate the association between gender and performance of EGD in patients diagnosed with GERD.
This study was conducted using electronic health record (EHR) data from the OneFlorida Clinical Data Research Network – a statewide network of health care systems that provide medical care to more than 40% of the population in Florida (the third most populous state in the US). We used ICD-9/10 codes to identify patients with GERD between 2012 and 2018 who had an endoscopic procedure post-GERD diagnosis. Rates of endoscopy were compared between males and females. The indication for the endoscopy varied. The primary outcome of interest was the rate EGD in males diagnosed with GERD compared to females with the same diagnosis. Patients were further divided into risk categories based on the number of risk factors for BE which included: age, race, smoking status, and obesity. We used Chi-square tests to examine gender differences in EGD. We reported odd ratios (OR), 95% confidence intervals (CI), and p-values.
Our database included 9,459,363 adult patients: 3,975,760 males and 5,483,603 females. Distributions of obesity (BMI >30), advanced age (>50 years), and white race were similar in males and females. Males were more likely to smoke than females (Table 1). The overall prevalence of GERD was slightly lower in males 9% (n=356,286) than females 12.1% (n=661,302), p<0.001. As expected, among all patients with GERD who had an EGD, the prevalence of BE was higher in males compared to females (22% vs. 12.8%, OR 1.71 [95%CI 1.67 – 1.75], p<0.001). Males with a diagnosis of GERD were significantly less likely to have an EGD compared to females (22.4% vs. 25%; OR .87 (95%CI .85 - .88), p<0.001). This trend was observed at various levels of risk factors as detailed in Figure 1. Even in males with multiple risk factors, the rate of EGD was stable around 22% while the rate in females trended up to 29% as seen in Figure 1.