title: Risk factors for Barrett's esophagus compared between African Americans and non-Hispanic Whites.
abstract: OBJECTIVE
  Esophageal adenocarcinoma is more common among non-Hispanic Whites (NHWs) than African Americans (AAs). It is unclear whether its precursor, Barrett's esophagus (BE), is also less common among AAs, and whether differences in risk factor profiles explain the racial disparity.
  
  
  METHODS
  Data were from a case-control study among eligible Veterans Affairs patients scheduled for an upper endoscopy, and a sample identified from primary care clinics. Participants completed a questionnaire on sociodemographic and clinical factors and underwent a study esophagogastroduodenoscopy. We calculated race-specific BE prevalence rates and used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for BE.
  
  
  RESULTS
  There were 301 BE cases and 1,651 controls. BE prevalence was significantly higher among NHWs than AAs (21.3 vs. 5.0%; P<0.001). NHWs were more likely than AAs to be male, have a high waist-to-hip ratio (WHR), hiatal hernia, and use proton-pump inhibitors (PPIs), but less likely to have Helicobacter pylori (P<0.001). Among cases, NHWs were more likely to have long-segment BE and dysplasia than AAs. Independent BE risk factors for AAs included a hiatus hernia ≥3 cm (OR 4.12; 95% CI, 1.57-10.81) and a history of gastroesophageal reflux disease or PPI use (OR, 3.70; 95% CI, 1.40-9.78), whereas high WHR (OR, 2.82; 95% CI, 1.41-5.63), hiatus hernia ≥3 cm (OR, 4.95; 95% CI, 3.05-8.03), PPI use (OR, 1.88; 95% CI, 1.33-2.66), and H. pylori (OR, 0.64; 95% CI, 0.41-0.99) were statistically significantly associated with BE risk for NHWs. Among all cases and controls, race was a risk factor for BE, independent of other BE risk factors (OR for AAs, 0.26; 95% CI, 0.17-0.38).
  
  
  CONCLUSIONS
  Among veterans, the prevalence of BE was lower in AAs compared with NHWs. This disparity was not accounted for by differences in risk estimates or prevalence of risk factors between NHWs and AAs.
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA.
authors.forename: Theresa H
authors.initials: TH
authors.lastname: Nguyen
authors.affiliation: Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Thrift
authors.affiliation: Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA.
authors.forename: David
authors.initials: D
authors.lastname: Ramsey
authors.affiliation: 1] Department of Pathology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA [2] Department of Pathology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Green
authors.affiliation: Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Yasser H
authors.initials: YH
authors.lastname: Shaib
authors.affiliation: Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: David Y
authors.initials: DY
authors.lastname: Graham
authors.affiliation: 1] Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA [2] Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000453:epidemiology / Q000208:ethnology* / Q000473:pathology; D016145:Endoscopy, Digestive System; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000453:epidemiology / Q000208:ethnology*; D016481:Helicobacter Infections / Q000453:epidemiology / Q000208:ethnology*; D016480:Helicobacter pylori; D006551:Hernia, Hiatal / Q000453:epidemiology / Q000208:ethnology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000453:epidemiology / Q000208:ethnology*; D011230:Precancerous Conditions / Q000453:epidemiology / Q000208:ethnology* / Q000473:pathology; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology / Q000208:ethnology; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data; D049629:Waist-Hip Ratio / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D054328:Proton Pump Inhibitors