P1348 - The Interaction Effect of Gender and Socio-Economic Status on the Incidence of COVID-19 in Patients With Gastroesophageal Reflux Disease: A Population-Based Study

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Presenting Author(s)

Sara Ghoneim, MD

University of Nebraska Medical Center
Omaha, NE, United States

Sara Ghoneim, MD¹, Sherif Saleh, MD², Nabil El Hage Chehade, MD², Abdul Mohammed, MD², Josue Davila, MD², Ronnie Fass, MD³
¹University of Nebraska Medical Center, Omaha, NE; ²MetroHealth Medical Center, Cleveland, OH; ³Esophageal and Swallowing Center, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH

Introduction: Reports on COVID-19 have shown gender and racial differences in health outcomes. Our aim was to examine the relationship between social determinants of health and risk of COVID-19 in patients with gastroesophageal reflux disease (GERD).

Methods: We analyzed medical records from a large population database (Explorys, IBM) pooled from 26 major healthcare systems across US. Only adult patients with diagnosis of GERD from January 1999-May 2021 and COVID-19 from December 2019-May 2021 were included. Data on gender, race/ethnicity, insurance status and PPI use were collected. Univariable and multivariable analyses were used for statistical analysis. Model was stratified by gender. Effect modification by PPI use was examined.

Results: We identified 6215670 GERD patients of which 4057825 (65%) used PPI, 2409175 (59%) were females and 1648650 (41%) were males. A total of 3605950 (58%) were uninsured. Cumulative incidence of COVID-19 among PPI users and non-users was 0.11% vs 0.04% (P< 0.001). In univariate analysis, odds (OR) of COVID-19 was highest among Caucasians 3.35 [3.11-3.6, P< 0.05], African Americans OR 2.9 [2.7-3.12, P< 0.05] and Hispanics OR 2.8 [2.6-3.0, P< 0.05]. Risk of COVID-19 was modified across all races if they were PPI users: Caucasians OR 2.83 [2.6-3.14, P< 0.001], African Americans OR 3.11 [2.8-3.5, P< 0.05] and Hispanics OR 1.9 [1.4-2.5, p< 0.05]. Lack of insurance was significantly associated with COVID-19 diagnosis OR 3.1 [2.9-3.3, P < 0.001]. In the multivariate model, after adjusting for covariates, African American race was the strongest independent risk factor for COVID-19 OR 4.8 [4.3-5.2], P< 0.001) followed by PPI use OR 2.9 [2.7-3.1, P< 0.001]. There was no clear association between Hispanic or Caucasian race and COVID-19 OR 0.99 [0.87-1.1, P=0.6] and OR 0.94 [0.86-1.0, P=0.2], respectively. When the model was stratified by gender, being female reduced the risk of COVID-19 in Hispanics OR 0.55 [0.2-0.7, P< 0.001]. Female gender did not modify COVID-19 risk in African Americans (OR 1.2 [1.0-1.4, P=0.53] or Caucasians OR 1.2 [1.0-1.4, P=0.9]. Patients with GERD who had public insurance such as Medicare OR 0.3 [0.2-0.31, P < 0.001] or Medicaid OR 0.4 [0.4-0.48, P< 0.001] had reduced risk of COVID-19 diagnosis compared to the uninsured.

Discussion: In GERD patients, COVID-19 diagnosis was highest among African Americans and PPI users. Female Hispanics were least likely to be diagnosed with COVID-19. Insurance status may indirectly influence susceptibility to COVID-19.

Figure: Figure 1. Multivariable regression analysis. A forest plot of gender differences for odds of COVID-19 diagnosis in patients with gastroesophageal reflux disease (GERD) based on race/ethnicity and public insurance type. Abbreviation: PPI, proton pump inhibitors.

	PPI users (N=4057825)			Non-PPI user (N=2157845)
Characteristics	Total	Prevalence	95% CI	Total	Prevalence (%)	95% CI
Caucasian
Yes	3,302,280	81.38	81.34-81.42	1,490,975	69.09	69.0-69.2
No	755,545	18.62	18.58-18.66	666,870	30.9	30.84-30.96
African-American
Yes	462,835	11.41	11.37-11.43	270,895	12.55	12.50-12.59
No	3,594,990	88.59	88.56-88.62	1,886,950	87.59	87.40-87.49
Hispanic
Yes	216,205	5.32	5.30-5.35	118,855	5.5	5.47-5.53
No	3,841,620	94.67	94.65-94.69	2,038,990	94.49	94.46-94.52
Race/Ethnicity mix
Caucasian-Hispanic	124,100	3.05	3.04-3.07	62,955	2.91	2.89-2.94
Caucasian-Non Hispanic	3,142,490	77.44	77.40-77.48	1,403,935	65.06	64.99-65.12
African American-Hispanic	5,345	0.13	0.12-0.14	4,130	0.19	0.18-0.20
African American-Non Hispanic	421,800	10.39	10.36-10.42	242,680	11.24	11.20-11.28
Hispanic	70,895	1.74	1.73-1.76	37,085	1.71	1.70-1.74
Mixed-Hispanic	15,865	0.39	0.38-0.40	14,685	0.68	0.66-0.69
Mixed-Non Hispanic	19,825	0.49	0.48-0.50	9,400	0.43	0.42-0.44
None	257,505	6.34	6.32-6.37	382,975	17.74	17.69-17.79
Gender
Male	1,648,650	40.62	40.58-40.68	878,510	40.71	40.64-40.77
Female	2,409,175	59.37	59.32-59.42	1,279,335	59.28	59.22-59.35
Medicare
Yes	1,532,795	37.77	37.72-37.82	554,285	25.68	25.62-25.74
No	2,525,030	62.22	62.17-62.27	1,603,560	74.31	74.25-74.37
Medicaid
Yes	452,285	11.14	11.11-11.18	193,245	8.95	8.91-8.99
No	3,605,540	88.85	88.82-88.88	1,964,600	91.04	91.00-91.08
Health insurance type
Medicare-Medicaid	102,715	2.53	2.51-2.55	20,175	0.93	0.92-0.94
Medicare only	1,430,080	35.24	35.19-35.29	534,110	24.75	24.69-24.80
Medicaid only	349,570	8.61	8.58-8.64	173,070	8.02	7.98-8.05
None	2,175,460	53.61	53.56-53.66	1,430,490	66.29	66.22-66.35
Health insurance coverage
Yes	1,882,365	46.39	46.34-46.44	727,355	33.71	33.64-33.77
No	2,175,460	53.61	53.56-53.66	1,430,490	66.29	66.22-66.35
COVID-19 diagnosis
Positive	4,675	0.11	0.11-0.12	885	0.04	0.03-0.04
Negative	4,053,150	99.88	99.88-99.89	2,156,960	99.96	99.95-99.96

Table: Table 1. Baseline Characteristics of Patients with Gastroesophageal Reflux Disease (GERD) Included in the Study. Abbreviations: PPI, proton pump inhibitors; CI, confidence interval.

Disclosures:

Sara Ghoneim indicated no relevant financial relationships.

Sherif Saleh indicated no relevant financial relationships.

Nabil El Hage Chehade indicated no relevant financial relationships.

Abdul Mohammed indicated no relevant financial relationships.

Josue Davila indicated no relevant financial relationships.

Ronnie Fass indicated no relevant financial relationships.

Sara Ghoneim, MD¹, Sherif Saleh, MD², Nabil El Hage Chehade, MD², Abdul Mohammed, MD², Josue Davila, MD², Ronnie Fass, MD³. P1348 - The Interaction Effect of Gender and Socio-Economic Status on the Incidence of COVID-19 in Patients With Gastroesophageal Reflux Disease: A Population-Based Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.