Neighborhood Disparities in Endoscopy Access for Hospitalized Patients with Upper Gastrointestinal Bleeding

Introduction : Acute upper gastrointestinal bleeding (UGIB) is a major gastrointestinal emergency, described as bleeding in areas of GI tract above the ligament of Treitz. It accounts for over 50% of admissions in the US. Studies have highlighted racial disparities in endoscopy, but little is known about the impact of neighborhood level factors on access to therapeutic endoscopy. Methods : We used the National Inpatient Sample data from 2016-2020 to sample patients with a UGIB and assessed endoscopic treatment, weekend admission, socio-demographics, and hospital characteristics. We conducted descriptive analysis, bivariate and multivariate logistic regressions to identify neighborhood disparities in access to endoscopy. Results : A total of 135,795 patients had acute UGIB, of which 22.15% had endoscopic treatment. More than two-thirds of endoscopies performed were in urban teaching hospitals, on weekdays, and in white elderly patients on Medicare. The probability of endoscopy increases in hospitals located in the Midwest (1.29, 1.16-1.44, p < .0001) or Northeast regions (1.19, 1.05-1.33, p = 0.005), but reduces 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). Conclusion: We identified lower rates of endoscopy on weekends, in rural and urban non-teaching and small or medium sized hospitals. Our findings suggest the need to improve access to endoscopy in underserved regions.