Native American children, young adults with eosinophilic esophagitis see barriers in care
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Key takeaways:
- Native American patients were five times as likely to have a family history of atopic dermatitis.
- They also had a higher likelihood of not receiving EoE treatment at the time of first surveillance EGD.
Native American youth have increased odds for feeding tube placement, not receiving eosinophilic esophagitis treatment upon diagnosis and barriers to health care access, according to a study in Annals of Allergy, Asthma and Immunology.
“Our medical center serves a large number of American Indian/Indigenous pediatric and young adult patients,” Bridget E. Wilson, MD, associate staff physician at Cleveland Clinic Children’s Pediatric Allergy/Immunology Center, told Healio.
“These patients are underrepresented in the medical literature evaluating atopic diseases, including eosinophilic esophagitis. The purpose of our study was to compare the presentation, history and management of pediatric and young adult American Indian/Indigenous patients vs. patients of other races with EoE.”
Methods
This single-center, retrospective, case-control study used data from patients seen from 2010 to 2024 with an EoE diagnosis. Researchers gathered demographic data on self-identified race and ethnicity of the patients and constructed a 4:1 control-to-case ratio of sex and current age-matched other race (Asian, Black, white or not reported) controls per Native American patient.
Data on clinical and laboratory diagnostics, first surveillance esophagogastroduodenoscopies (EGDs), EoE treatments, comorbid atopic and gastrointestinal diagnoses and family medical history were also obtained.
Researchers conducted both an all-ages analysis and an analysis stratified by age at EOE diagnosis, including ages 0 to 4 years and ages 5 to 18 years and older.
Results
Within the study, there were 17 Native American patients (64.7% male) and 68 controls (64.7% male). The average EoE diagnosis age for Native American patients was 6.9 years, with 53% being diagnosed between ages 0 and 4 years, compared with 7.7 years for children of other races.
The odds ratio of having private medical insurance among all ages was decreased for Native American patients (OR = 0.2; 95% CI, 0.06-0.64).
Among Native American patients aged 5 to 18 years and older, abdominal pain and gastroesophageal reflux were more common symptoms at presentation compared with the control patients (OR = 9.33; 95% CI, 1.04-84.2 and OR = 10.67; 95% CI, 1.72-65.99, respectively).
In Native American patients of all ages, researchers found a seven-fold increase in odds for current or past gastronomy tube (OR = 7.07; 95% CI, 1.08-46.34). An association was also found between Helicobacter pylori infection and the Native American patient group (OR = 7.07; 95% CI, 1.08-46.34).
More than a five-fold increase in odds was observed in Native American patients aged 0 to 4 years and having a family history of atopic dermatitis (OR = 5.63; 95% CI, 1.15-27.44).
In terms of endoscopic and pathologic differences, Native American patients aged 5 to 18 years or older had decreased odds for linear furrows at EoE diagnosis (OR = 0.174; 95% CI, 0.03-0.997).
Differences in average eosinophils/high power field (eos/hpf) were also found in Native American patients vs. controls at 0 to 4 years old (61.56 ± 37.37 vs. 29.27 ± 30.56; P = .01), and in peak eos/hpf in patients aged 5 to 18 years or older (29.75 ± 19.36 vs. 64.14 ± 28.16). There was also a difference in eos/hpf distal esophagus in Native American patients vs. controls aged 5 to 18 years or older (22.25 ± 18.36 vs. 44.11 ± 26.93; P = .04).
In Native American patients aged 5 to 18 years and older, the average number of months between diagnostic and surveillance EGD was more than double compared with the control group (11.29 vs. 4.94 months); however, the researchers said this was not a significant finding. Among all age groups, Native American patients had higher odds for not having an EoE treatment at the first surveillance EGD compared with the control patients (18% vs. 3%; OR = 7.07; 95% CI, 1.08-46.34).
“This is the largest study of American Indian/Indigenous patients with EoE described to date,” Wilson said. “However, the number of patients included in our single center study is relatively small, so there should be caution in broadly generalizing the results.”
She further explained that there were some significant differences in the clinical presentation, endoscopic findings, treatment, medical history and family history noted between the racial groups that could suggest potential disparities and barriers to EoE diagnosis and subsequent care for Native American patients. Biological differences could also be a contributing factor, but future studies are needed to clarify this hypothesis, according to Wilson.
“Doctors and other health care providers should be aware of potential disparities and barriers to medical care among patients of American Indian/Indigenous race and other patient populations,” she said. “It is important for doctors and medical providers to provide culturally-informed care and clearly communicate with all patients.”
There are certain actions that can help in addressing the access to care issue, Wilson told Healio. She highlighted that partnerships between subspecialists with expertise in EoE and the Indian Health Service/medical centers serving large Native American /Indigenous populations may help address disparities in care.
“Additionally, telemedicine and offering less-invasive EoE surveillance techniques (ie, esophageal string test, transnasal endoscopy) at local health centers may improve access to EoE care,” Wilson said. “Prospective, multicenter studies including larger numbers of patients can help clarify potential differences between American Indian/Indigenous patients and those of other racial groups.”
For more information:
Bridget E. Wilson, MD, can be reached at wilsonb36@ccf.org
Perspective
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I am pleased to see this paper, as studying minority groups such as Native Americans with EoE is important.
The results are a bit surprising given how many differences were found between the Native Americans vs. the other cohort(s).
The findings should be considered preliminary but deserve further attention.
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