Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA.
Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA.
Am J Gastroenterol. 2014 Dec;109(12):1870-80. doi: 10.1038/ajg.2014.351. Epub 2014 Nov 25.
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.
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.
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).
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.
食管腺癌在非西班牙裔白人（NHWs）中比非裔美国人（AAs）更为常见。目前尚不清楚其前体 Barrett 食管（BE）在 AAs 中是否也较为少见，以及风险因素谱的差异是否解释了这种种族差异。
数据来自一项在符合条件的退伍军人事务部患者中进行的上消化道内镜检查的病例对照研究，以及从初级保健诊所中确定的样本。参与者完成了一份关于社会人口统计学和临床因素的问卷，并进行了研究性食管胃十二指肠镜检查。我们计算了种族特异性 BE 的患病率，并使用逻辑回归估计 BE 的比值比（OR）和 95%置信区间（95%CI）。
共有 301 例 BE 病例和 1651 例对照。NHWs 中 BE 的患病率明显高于 AAs（21.3% vs. 5.0%；P<0.001）。与 AAs 相比，NHWs 更可能是男性，具有较高的腰围-臀围比（WHR）、食管裂孔疝和使用质子泵抑制剂（PPIs），但更不可能感染幽门螺杆菌（P<0.001）。在病例中，NHWs 比 AAs 更有可能患有长节段 BE 和异型增生。AAs 中 BE 的独立风险因素包括疝≥3cm（OR 4.12；95%CI，1.57-10.81）和胃食管反流病或 PPI 使用史（OR，3.70；95%CI，1.40-9.78），而高 WHR（OR，2.82；95%CI，1.41-5.63）、疝≥3cm（OR，4.95；95%CI，3.05-8.03）、PPI 使用（OR，1.88；95%CI，1.33-2.66）和 H. pylori（OR，0.64；95%CI，0.41-0.99）与 NHWs 中 BE 风险显著相关。在所有病例和对照组中，种族是 BE 的风险因素，独立于其他 BE 风险因素（AAs 的 OR，0.26；95%CI，0.17-0.38）。
在退伍军人中，与 NHWs 相比，AAs 中的 BE 患病率较低。这种差异不能用 NHWs 和 AAs 之间风险估计或风险因素的差异来解释。
