Eosinophilic esophagitis incidence, prevalence growing
Key takeaways:
- The study examined health insurance claims data from July 1, 2020, through June 30, 2023.
- Eosinophilic esophagitis was most common among patients aged 18 to 64 years and among men.
SAN DIEGO — The incidence and prevalence of eosinophilic esophagitis in the United States are higher than previously reported, indicating increased disease burden, according to a poster presented here.
EoE can have a drastic impact on quality of life, Matthew Greenhawt, MD, MBA, MSc, FAAAAI, director of the food challenge and research unit at Children’s Hospital Colorado, told Healio.
“EoE is associated with esophageal dysfunction, meaning that for many patients, the act of swallowing food can be difficult and even painful, often with the feeling that food may be stuck or is passing into the stomach slowly,” he said.
Greenhawt led the retrospective, observational cohort study, which was presented at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress.
Associated symptoms such as reflux and chest pain, nausea and vomiting can make eating challenging and unenjoyable as well, he continued.
“Treatments that involve dietary restriction or having to take medications twice daily can add stress to one’s life and be difficult from an adherence standpoint. As well, patients with EoE may have been misdiagnosed or not diagnosed at all for years, and the process is chronic,” he added. “For all these reasons, there can be a significant impact on quality of life.”
The examination of health insurance claims data in the MarketScan database found 73,512 patients (59.3% male) with one inpatient or outpatient claims or more for EoE between July 1, 2020, and June 30, 2023.
The cohort included 19.4% who were aged 17 years and younger, 77.1% aged 18 to 64 years and 3.5% who were aged 65 years and older. Also, 77% had commercial insurance, 2.6% had Medicare and 20.4% had Medicaid.
Incidence rate, defined as the proportion of patients with 12 months or more of continuous months of health plan enrollment and no EoE diagnosis prior to the index date with one diagnostic code for EoE in the database, was calculated per 100,000 patient-years. Prevalence, defined as the number of patients with EoE divided by the total number of patients in the database with one or more continuous months of enrollment, was calculated per 100,000 individuals.
These cases represented a cumulative incidence rate of 33.9, or 0.6%. The cumulative prevalence was 147.4, or 0.15%.
For two or more insurance claims, Greenhawt said, incidence was 15.3, and prevalence was 79.
By age group, incidence rates included 19.2 aged 17 years and younger, 42.3 aged 18 to 64 years, and 22.6 aged 65 years and older.
Similarly, prevalence rates included 100.5 aged 17 years and younger, 173.9 aged 18 to 64 years, and 83.8 aged 65 years and older.
Men experienced incidence rates of 42.3 and prevalence rates of 184.9, and women experienced incidence rates of 26.5 and prevalence rates of 113.7.
Among patients with commercial insurance, incidence was 42.5 and prevalence was 177.3. Among those with Medicare, incidence was 29.6 and prevalence was 120.3. Patients with Medicaid had an incidence of 20.5 and a prevalence of 91.7.
Previous research by Hahn and colleagues found a global incidence of 6.8 per 100,000 person-years and a global prevalence of 74.4 per 100,000 individuals between 2017 and 2022, Greenhawt said. This research also found an incidence of 10.8 per 100,000 person-years and a prevalence of 55.4 per 100,000 individuals in the United States between 1976 and 2022.
Another study by Thel and colleagues using 2022 data from MarketScan and 2017 data from Medicare estimated a prevalence of 67.1 per 100,000 individuals with two or more insurance claims for EoE and a prevalence of 142.5 per 100,000 individuals with one or more insurance claims, Greenhawt continued.
These findings can inform care in a few ways, Greenhawt said.
“First, EoE is not a rare disease, and both the incidence and prevalence are steadily increasing,” he said. “Second, while this affects patients of all races, incomes, insurances, and both males and females, there are a few disparities that are important to consider.”
Greenhawt noted the greater prevalence of claims among patients aged 18 to 64 years and among males, with less common claims among patients with Medicare and Medicaid.
“It is unclear if the insurance trends indicate that this is underdiagnosed among Medicare and Medicaid,” he said.
Research will continue, Greenhawt added.
“There are multiple applications, such as exploring total costs of care, how costs and service utilization may differ based on particular specialist involvement in the care or lack of specialist involvement or based on particular medication use,” he said. “These claims databases are fantastic resources for exploring an infinite number of questions.”
References:
- Hahn JW, et al. Clin Gastroenterol Hepatol. 2023;doi:10.1016/j.cgh.2023.06.005.
- Thel HL, et al. Clin Gastroenterol Hepatol. 2024;doi:10.1016/j.cgh.2024.09.031.
For more information:
Matthew Greenhawt, MD, MBA, MSc, FAAAAI, can be reached at matthew.greenhawt@childrenscolorado.org.