P04.2. Social Determinants of Health Predict Barrett’s Esophagus Screening Completion

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ID: 325950
2026
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Ranked #261 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Benign Disease: Barrett’s Esophagus: Pathology and Pathophysiology; Non-invasive Neoplasia Background Only 15-20% of eligible patients undergo endoscopic screening for Barrett’s esophagus (BE) despite guidelines recommendations. It is unclear whether social determinants of health (SDH) are associated with completion of screening endoscopy. The aim of this study is to investigate the impact of SDH on BE screening using data from a large U.S. academic health system. Methods This was a retrospective, single center study of adults evaluated in primary care settings within the University of North Carolina (UNC) health system between 2015-2019. Data was obtained from the Carolina Data Warehouse (CDW), a central data repository containing clinical data from UNC Health. Patients meeting BE screening criteria were included. Screening eligibility was determined using American College of Gastroenterology (ACG) criteria, defined as a history of longstanding gastroesophageal reflux disease (GERD) with ≥3 additional BE risk factors (age >50 years, male sex, White race, obesity, tobacco smoking, and family history of BE or esophageal adenocarcinoma). The primary outcome was completion of screening endoscopy among eligible patients, stratified by individual social determinants of health (SDH). SDH included race, sex, marital status, employment status, and insurance status. Additional factors assessed included age, tobacco use, and body mass index (BMI). Multivariable logistic regression was used to identify independent predictors of screening completion. Results A total of 9,838 patients met screening criteria for BE and were seen in a primary care or internal medicine clinic between 2015 to 2019. Of these, 864 (8.8%) underwent screening endoscopy. The median age was similar among screened and unscreened patients (61 vs. 62 years). Screening was more common in females than males (10% vs. 8%; adjusted odds ratio (aOR) 1.24, 95% CI 1.07-1.43) and less common in older age groups (age 65-69: aOR 0.69, 95% CI 0.52-0.9) [Table 1]. Smokers were no more likely to undergo screening than non-smokers. Individuals with any history of being uninsured were about half as likely to undergo screening (7% vs. 13%; aOR 0.52, 95% CI 0.45-0.6). Conclusion In this large academic health system, less than 10% of eligible patients underwent screening for BE. While male sex and older age are well-established risk factors for BE, females and younger patients were more likely to be screened. Social determinants of health also influenced access to endoscopy, as individuals with any history of being uninsured were half as likely to undergo screening endoscopy. Patients least likely to harbor BE and dysplasia (younger age, female) were most likely to be screened.
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Authors Natalie Wilson, Michelle Russin, Shilpa Karanjit, Chelsea Anderson, Nicholas Shaheen
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.001
URL
https://doi.org/10.1093/dote/doag077.001
Keywords Keywords not found

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