背景和研究目的社会经济剥夺长期以来与许多胃肠道疾病有关,但其对食管胃十二指肠镜(EGD)诊断的影响尚未评估.这项研究的目的是调查剥夺对EGD结局的影响,而与转诊原因无关。患者和方法从2019年6月开始,在威尔士的四个卫生委员会就诊的2000名连续患者进行了回顾性研究,并使用威尔士多重剥夺指数(WIMD)计算了剥夺评分。患者被细分为五分之一进行分析(第一季度大多数,Q5最少被剥夺)。结果最贫困地区的居民更容易被诊断为消化性溃疡(Q17.9%,Q54.7%;比值比[OR]0.498,P=0.018),严重食管炎(LA4,Q12.7%vQ50%,或0.089,P0.002),幽门螺杆菌感染(Q15.4%,Q51.7%;OR0.284,P=0.002),但不太可能被诊断为巴雷特食管(第一季度6.3%对第二季度12.3%,OR2.146,P=0.004)比来自最不贫困地区的人。新的癌症诊断人数为53,在紧急疑似癌症就诊后比例更高(南加州大学,n=35,4.6%)比常规转诊(n=3,0.6%,P<0.001)。剥夺与更晚期的癌症相关(III期Q116.7%vQ55.6%,OR0.997,P=0.006:第四阶段Q116.7%vQ238.9%vQ522.2%,OR0.998,P=0.049)。结论剥夺与消化性溃疡的两倍相关,幽门螺杆菌感染增加了三倍,和12倍严重的食管炎,和更晚期的癌症阶段。
Background and study aims Socioeconomic deprivation has long been associated with many gastrointestinal diseases, yet its influence on esophagogastroduodenoscopy (EGD) diagnosis has not been evaluated. The aim of this study was to investigate the influence of deprivation on outcomes of EGD irrespective of referral reason. Patients and methods Two thousand consecutive patients presenting to four Health Boards in Wales beginning in June 2019 were studied retrospectively with deprivation scores calculated using the Wales Indices of Multiple Deprivation (WIMD). Patients were subclassified into quintiles for analysis (Q1 most, Q5 least deprived). Results Inhabitants of the most deprived areas were more likely to be diagnosed with peptic ulcer (Q1 7.9%, Q5 4.7%; odds ratio [OR] 0.498, P =0.018), severe esophagitis (LA4, Q1 2.7% v Q5 0%, OR 0.089, P 0.002), Helicobacter pylori infection (Q1 5.4%, Q5 1.7%; OR 0.284, P =0.002), but less likely to be diagnosed with Barrett\'s esophagus (Q1 6.3% v Q5 12.3%, OR 2.146, P =0.004) than those from the least deprived areas. New cancer diagnoses numbered 53 and were proportionately higher after presentation for urgent suspected cancer (USC, n=35, 4.6%) than for routine referrals (n=3, 0.6%, P < 0.001). Deprivation was associated with more advanced stage cancer (stage III Q1 16.7% v Q5 5.6%, OR 0.997, P =0.006: stage IV Q1 16.7% v Q2 38.9% v Q5 22.2%, OR 0.998, P =0.049). Conclusions Deprivation was associated with two-fold more peptic ulcer disease, three-fold more H. pylori infection, and 12-fold more severe esophagitis, and more advanced cancer stage.