Impact of Ethnicity in Upper Gastrointestinal Hemorrhage
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BACKGROUND AND AIMS: Upper gastrointestinal hemorrhage (UGIH) is a serious condition, with considerable morbidity and mortality. Thus, we aimed to examine the role of ethnicity in UGIH outcomes. METHODS: We analyzed 2196 consecutive patients admitted with acute UGIH between January 2006 and February 2012. Data (including complete demographic and clinical data) was gathered prospectively and entered into our GI Bleed Registry, which captures multiple demographic and clinical variables. Results were analyzed using the Chi-square analyses and the analysis of variance techniques with Tukey multiple comparisons. RESULTS: Among 2196 patients, 620 (28%) were Black, 625 (29%) White, 881 (40%) Hispanic, and 70 (3%) were members of other ethnic groups. Males outnumbered females by approximately 2:1 (p=0.01). ASA (18%; p<0.001) and NSAID (17% p=0.007) use was common across ethnic groups. Smoking and illicit drug use was highest in Whites (63% and 31%), and Blacks (62% and 31%). Alcohol use was highest in Hispanics (63%) and Whites (63%). The most frequently identified causes of UGIH include gastric and duodenal ulcers (25%), esophageal varices (25%), and esophagitis (12%). Among the 3 main ethnicities, Blacks frequently had UGIH due to gastroduodenal ulcers (32%), while Hispanics most commonly bled from esophageal varices (34%). Ulcer disease and esophageal varices in Whites were found equally (25%). Causative bleeding varied with age. More Black (50%) and White patients (44%) bled between 50-64 years, while 40% of Hispanics bled between 35-49. The most common cause of bleeding in patients younger than 35 or older than 65 years was gastroduodenal ulcer disease. Overall, rebleeding rates were significantly lower in Whites (5.8%) than in Hispanics (9.9%) or Blacks (8.7%) (p = 0.02). Looking at outcomes in patients with variceal or gastroduodenal ulcers, Blacks had a higher mortality rate (7% and 11%), while Whites had a lower mortality rate (5% and 5%). Hispanics with varices had higher rebleeding rates (13%) but the lowest mortality (6%). CONCLUSIONS: By examining an ethically large and diverse population, we conclude that the etiology and outcome of UGIH has specific trends across age and ethnic groups. Hispanics were more likely to have esophageal varices and higher rebleeding rates, while Blacks were more likely to have ulcers and the highest mortality overall. Whites were equally likely to have ulcers or varices, but a lower rate of rebleeding. UGIH frequently occurs between the ages of 34-49; however, patients over 65 were more likely to have ulcers.