National Inpatient Sample Analysis of Gender Differences in Patients With Eosinophilic Esophagitis

Introduction: Eosinophilic Esophagitis (EoE) is a chronic inflammatory process of the esophagus often associated with structural and motility problems. Previous studies have shown an increased prevalence in males over females, however there is little data exploring the risk of esophageal complications among genders which may be indicative of disease severity. Methods: This is a retrospective cohort study using National Inpatient Sample data including adults hospitalized between 2016 and 2020 presenting with previously or newly diagnosed Eosinophilic Esophagitis. The primary outcome measured was inpatient complications related to the patient’s history of EoE. Statistical analyses were all performed using STATA software. Results: Of the 21,755 patients with history of EoE, 17,130 (79%) were White and 11,260 (52%) were males. Of the comorbidities assessed, there was a statically significant relationship (P< 0.05) of smoking and alcohol use in males and relationship of obesity class 3, diabetes, and asthma in females. As shown in Table 1, males were at increased risk of EoE complications including esophageal obstruction (OR= 1.529; 95% CI 1.529-1.819), requiring esophageal dilation (OR= 2.818; 95% CI 1.205-6.591), requiring esophageal laceration repair (OR= 12.193; 95% CI 1.594-93.275), esophageal food bolus (OR= 2.841; 95% CI 2.186-3.693), esophageal rupture (OR= 4.098; 95% CI 2.657-6.322), and esophageal perforation (OR= 4.136; 95% CI 1.563-10.945). Males were also at increased risk for requiring mechanical ventilation (OR= 2.208; 95% CI 1.479-3.296). There was no statistically significant association (P >0.05) of gender and esophageal hemorrhage, blood transfusions, requiring vasopressors, sepsis, shock, and mortality. Conclusion: In general, males were more likely to present with every esophageal complication except for esophageal hemorrhage which was equivocal. Males are most likely to present with esophageal perforation or rupture and were much more likely to require esophageal laceration repair with an odds ratio of 12.193. Despite male developing more esophageal complications, there is no statistically significant difference in requiring blood transfusions, required vasopressors, developing sepsis, developing shock and mortality between males and females. Our data supports existing literature about the skewed prevalence of EoE and EoE related complications in males using most recently available national inpatient data. Table 1. - Comparing demographics, comorbidities, Charlson Comorbidity Index, and inpatient complications in males and females with eosinophilic esophagitis Eosinophilic Esophagitis in Males (n = 11260) Eosinophilic Esophagitis in Females (n = 10495) P Value Demographics Mean Age, years 46.1 48.9 < 0.001 Race, n White 9055 (80.4%) 8075 (76.9%) 0.006 Black 720 (6.4%) 975 (9.3%) 0.001 Hispanic 704 (6.3%) 615 (5.9%) 0.575 Asian or Pacific Islander 115 (1.0%) 160 (1.5%) 0.158 Native American 25 (0.2%) 20 (0.2%) 0.818 Other 270 (2.4%) 235 (2.2%) 0.719 Obesity Class, n Class 1 445 (4.0%) 480 (4.6%) 0.310 Class 2 300 (2.7%) 335 (3.2%) 0.295 Class 3 300 (2.7%) 795 (7.6%) < 0.001 Comorbidities Diabetes, n 1345 (11.9%) 1490 (14.2%) 0.028 Hypertension, n 3330 (29.6%) 2865 (27.3%) 0.094 Congestive Heart Failure, n 700 (6.2%) 790 (7.5%) 0.095 COPD, n 730 (6.5%) 675 (6.4%) 0.938 ESRD, n 165 (1.5%) 200 (1.9%) 0.272 Cerebrovascular Disease, n 340 (3.0%) 285 (2.7%) 0.549 Smoking History, n 3350 (29.8%) 2460 (23.4%) < 0.001 Alcohol Use Disorder, n 1020 (9.1%) 500 (4.8%) < 0.001 Drug Use, n 690 (6.1%) 550 (5.2%) 0.203 Cancer, n 450 (4.0%) 315 (3.0%) 0.083 Dementia, n 170 (1.5%) 165 (1.6%) 0.871 Malnutrition, n 490 (4.4%) 510 (4.9%) 0.441 Cirrhosis, n 295 (2.6%) 215 (2.1%) 0.218 Atopic Dermatitis, n 25 (0.2%) 30 (0.3%) 0.675 Asthma, n 1970 (17.5%) 2655 (25.3%) < 0.001 Charlson Comorbidity Index, n 0 4805 (42.7%) 3970 (37.8) 0.001 1 3135 (27.8%) 3350 (31.9) 0.004 2 1475 (13.1%) 1440 (13.7) 0.562 3 735 (6.5%) 625 (6.0%) 0.429 4 460 (4.1%) 530 (5.1%) 0.129 5 or more 650 (5.8%) 580 (5.5%) 0.721 Complications Esophageal Dilation, n 120 (1.1%) 40 (0.4%) 0.0125 Esophageal Laceration Repair, n 65 (0.6%) 5 (0.1%) 0.0020 Esophageal Obstruction, n 1920 (17.1%) 1245 (11.9%) < 0.0001 Esophageal Food Bolus, n 1165 (10.4%) 410 (3.9%) < 0.0001 Esophageal Rupture, n 550 (4.9%) 130 (1.2%) < 0.0001 Esophageal Hemorrhage, n 25 (0.2%) 15 (0.1%) 0.5418 Esophageal Perforation, n 110 (1.0%) 25 (0.2%) 0.0019 Blood Transfusion, n 600 (5.3%) 460 (4.4%) 0.1549 Mechanical Ventilation, n 440 (3.9%) 190 (1.8%) 0.0001 Vasopressors, n 45 (0.4%) 50 (0.5%) 0.7046 Sepsis, n 855 (7.6%) 725 (6.9%) 0.3701 Shock, n 140 (1.2%) 110 (1.1%) 0.5512 Mortality, n 70 (0.6%) 65 (0.6%) 0.9912 Abbreviations: COPD = Chronic Obstructive Pulmonary Disease, ESRD = End-Stage Renal Disease.