Black Patients Less Likely to Receive Helicobacter pylori Eradication Testing

h pylori
h pylori in stomach
Investigators of the retrospective cohort study evaluated adherence to guideline-supported eradication testing for Helicobacter pylori infection.

Black patients were found to be 38% less likely to receive eradication testing after receiving treatment for Helicobacter pylori infection compared with White patients, according to data from a retrospective cohort study presented at the 2020 American College of Gastroenterology (ACG) Annual Scientific Meeting. After the investigators controlled for variables, the odds ratio was 0.62 (95% CI, 0.48-0.79).

Disparities in eradication testing extended beyond Black and White patients. Testing was performed 32.2% of the time in White patients vs 30.5% of the time for Black patients, and similar trends were seen in patients of other races/ethnicities (P <.001). For example, Asian patients received testing in 35.1% of the applicable instances, and Hispanic patients or patients of other backgrounds were tested on 36.7% of these occasions (P <.001).

Findings suggested that the clinical setting mattered; patients evaluated in gastroenterology clinics had higher rates of eradication testing than those assessed in non-GI clinics (P <.001). Of the 622 patients who had eradication testing performed, 52.4% were seen at a GI-specific clinic, 34.6% at an internal medicine clinic, and 33.0% at a family medicine clinic. The remaining 33.3% of patients were seen at “other” clinics.

Eradication testing rates were also found to decrease over time, despite the ACG’s publication of a clinical guideline for the treatment of H pylori infection in February 2017. Data demonstrated that eradication testing rates fell from 43.1% in 2016 to 35.9% and 25.5% in 2017 and 2018, respectively (P <.0001). Choice of the initial test modality (ie, serum antibody, urease breath test, stool antigen, and biopsy) also “significantly differed” over time, the investigators said (P =.01).

The retrospective analysis included 1711 adults diagnosed with H pylori between June 1, 2016 and June 30, 2018. The study authors extracted patient data from electronic health records in a large academic health system. Most patients’ H pylori diagnoses (71%) were uncovered via serum antibody testing. The patient pool was largely female (63%), insured (90%), and non-White (66%). Ninety percent of the 622 patients who had eradication testing achieved cure.

The “significant variability” seen in the management of H pylori infection underscored “substantial racial disparities in eradication testing,” the study authors stated. These inconsistencies are clinically impactful considering that H pylori infection is known to disproportionately affect racial and ethnic minority groups.

“Future prospective studies in racially/ethnic diverse populations controlling for social determinants of health are needed to understand the mechanisms resulting in the observed racial disparity in eradication testing,” they concluded.

Disclosure: 2 study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of the authors’ disclosures.

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Reichstein J, Parish A, Garbarino S, et al. Variations and racial disparities in Helicobacter pylori guideline adherence for eradication testing. Presented at: American College of Gastroenterology Annual Scientific Meeting; October 26-28, 2020. Abstract S1332.