Race, ethnicity, sex and temporal differences in Barrett's oesophagus diagnosis: a large community-based study, 1994-2006

Abstract

Objective: To evaluate the demographics and incidence of Barrett's oesophagus diagnosis using community-based data.

Design: Observational study.

Setting: Kaiser Permanente, Northern California healthcare membership, 1994-2006.

Patients: Members with an electronic diagnosis of Barrett's oesophagus.

Main outcome measures: Incidence and prevalence of a new Barrett's oesophagus diagnosis by race, sex, age and calendar year.

Results: 4205 persons met the study definition for a diagnosis of Barrett's oesophagus. The annual incidence in 2006 was highest among non-Hispanic whites (39/100,000 race-specific member-years, 95% confidence interval (95% CI) 35 to 43), with lower rates among Hispanics (22/100,000, 95% CI 16 to 29), Asians (16/100,000, 95% CI 11 to 22), and blacks (6/100,000, 95% CI 2 to 12). The annual incidence was higher among men than women (31 vs 17/100,000, respectively, year 2006; p<0.01). The incidence increased with age from 2 per 100,000 for persons aged 21-30 years, to a peak of 31 per 100,000 member-years for persons aged 61-70 years (year 2006). There was no increase in the incidence of new diagnoses until the last two observation years, which coincided with changes in data collection methods and may be due to bias. The overall prevalence among active members increased almost linearly to 131/100,000 member-years by 2006.

Conclusions: The demographic distributions of Barrett's oesophagus differ markedly by race, age and sex and were comparable to those for oesophageal adenocarcinoma. Thus, demographic disparities in oesophageal adenocarcinoma risk may arise partly from the risk of having Barrett's oesophagus, rather than from differing risks of progression from Barrett's oesophagus to cancer. There has been an almost linear increase in the prevalence of diagnosed disease.

Figure 1

Incidence of Barrett’s oesophagus diagnosis per 100 000 member-years, crude and adjusted for endoscopic volume, by year of diagnosis, 1998–2006. *Endoscopy rate is the number of unique persons per 1000 member-years who received an upper endoscopy in each given year. Vertical bars represent 95% confidence intervals.

Figure 2

Incidence of the diagnosis of Barrett’s oesophagus per 100 000 member-years by age, crude and adjusted for endoscopic volume, year 2006. *Endoscopy rate is the number of unique persons per 1000 member-years within each age interval who received an upper endoscopy in 2006. Age points approximate the centre of each 10 year interval (eg, 65 is the centre of the interval for ages 61–70 years). Vertical bars represent 95% confidence intervals.

Figure 3

Prevalence of diagnosed Barrett’s oesophagus per 100 000 member-years by year of diagnosis and sex, 1994–2006. The year 1994 is the first year electronic diagnoses were recorded. Vertical bars represent 95% confidence intervals.

Figure 4

Prevalence of diagnosed Barrett’s oesophagus per 100 000 member-years by year of diagnosis and race and race/ethnicity, 1994–2006. The year 1994 is the first year electronic diagnoses were recorded.