Analyzing Eosinophilic Esophagitis Health Disparities

Are there disparities in care for patients with eosinophilic esophagitis?

Eosinophilic esophagitis (EoE), a chronic allergy-related condition of the esophagus, has been increasing in prevalence for the past three decades. During this time, doctors have been working to uncover more about this condition — learning who is most impacted, what causes and triggers the disease, and different avenues of care. Children’s Hospital Colorado has a significantly larger EoE patient population compared to other hospitals across the country, so pediatric gastroenterologist Pooja Mehta, MD, decided to analyze data from these children to discover trends in care.

For the past 10 years, Dr. Mehta and her team have studied the EoE patient population, which includes more than 2,000 kids at Children’s Colorado. Together, they analyzed demographic features and compared them to how patients’ conditions were managed to see whether race, ethnicity or broader social determinants of health had an impact on care. The team used a gauge called the Area Deprivation Index (ADI) to look granularly at each patient’s address to determine their neighborhood’s level of advantage or disadvantage based on the surroundings. The ADI factors in income, education level, housing quality and employment.

“The importance of using the ADI is really trying to understand if there are barriers in diagnosing EoE,” Dr. Mehta says. “Are there structural factors that are playing a role in preventing children who might be from these marginalized communities from getting an appropriate diagnosis or to getting equal care?”

Understanding disparities in EoE care

The team’s findings tell a story, and there may in fact be differences in diagnosis and management of EoE that need to be explored further. The study found that Black children tended to be younger at diagnosis than white children, and while more research is needed, the group speculates that this is because only Black children with more severe disease features are being seen and treated. Dr. Mehta worries this could mean other more mild cases are slipping through the cracks and not receiving a proper diagnosis or treatment.  

“Could it possibly be that kids who have more subtle symptoms are not getting appropriate care or are not getting evaluated?” Dr. Mehta asks.

The findings also showed that children living in rural areas were seen by feeding therapy specialists less often, and children from more disadvantaged neighborhoods had fewer instances of radiographic evaluation of their disease. Both of these findings indicate that future research should examine each patient’s ease of access to a pediatric specialist. “Because EoE requires seeing a pediatric gastroenterologist and having an endoscopy for diagnosis, if you don’t ever see a pediatric gastroenterologist, you’re never going to be diagnosed,” Dr. Mehta adds. 

“The reason we’re finding these disparities is likely not genetics,” she says. “It is due to these kinds of structural factors, historical racism, and then poverty and inequity that play a big role in diagnosis and management. Institutions are really trying to take a deeper dive to ask, ‘Is there equal access? Do we have policies that promote equity, not equality?’”  

Her plan is to share this data with colleagues widely to create an opportunity for a bigger conversation.

“I would want colleagues to take a deep dive into their data and use it as an opportunity for growth and learning,” Dr. Mehta says. “This research is really patient-centric. It’s making sure that we keep our patients in mind in everything that we do, and constantly reassess whether we are providing the best care.”

1. Mehta, Pooja et al. “Examining Disparities in Pediatric Eosinophilic Esophagitis.” The journal of allergy and clinical immunology. In practice vol. 11,9 (2023): 2855-2859. doi:10.1016/j.jaip.2023.06.011.