S413 The Interaction Effect of Gender and Socio-Economic Status on the Incidence of COVID-19 in Patients With Gastroesophageal Reflux Disease: A Population-Based Study

Abstract

Introduction: Reports on COVID-19 have shown gender and racial differences in health outcomes. Our aim was to examine the relationship between social determinants of health and risk of COVID-19 in patients with gastroesophageal reflux disease (GERD). Methods: We analyzed medical records from a large population database (Explorys, IBM) pooled from 26 major healthcare systems across US. Only adult patients with diagnosis of GERD from January 1999-May 2021 and COVID-19 from December 2019-May 2021 were included. Data on gender, race/ethnicity, insurance status and PPI use were collected. Univariable and multivariable analyses were used for statistical analysis. Model was stratified by gender. Effect modification by PPI use was examined. Results: We identified 6215670 GERD patients of which 4057825 (65%) used PPI, 2409175 (59%) were females and 1648650 (41%) were males. A total of 3605950 (58%) were uninsured. Cumulative incidence of COVID-19 among PPI users and non-users was 0.11% vs 0.04% (P< 0.001). In univariate analysis, odds (OR) of COVID-19 was highest among whites 3.35 [3.11-3.6, P< 0.05], African Americans OR 2.9 [2.7-3.12, P< 0.05] and Hispanics OR 2.8 [2.6-3.0, P< 0.05]. Risk of COVID-19 was modified across all races if they were PPI users: whites OR 2.83 [2.6-3.14, P< 0.001], African Americans OR 3.11 [2.8-3.5, P< 0.05] and Hispanics OR 1.9 [1.4-2.5, p< 0.05]. Lack of insurance was significantly associated with COVID-19 diagnosis OR 3.1 [2.9-3.3, P < 0.001]. In the multivariate model, after adjusting for covariates, African American race was the strongest independent risk factor for COVID-19 OR 4.8 [4.3-5.2], P< 0.001) followed by PPI use OR 2.9 [2.7-3.1, P< 0.001]. There was no clear association between Hispanic or white race and COVID-19 OR 0.99 [0.87-1.1, P=0.6] and OR 0.94 [0.86-1.0, P=0.2], respectively. When the model was stratified by gender, being female reduced the risk of COVID-19 in Hispanics OR 0.55 [0.2-0.7, P< 0.001]. Female gender did not modify COVID-19 risk in African Americans (OR 1.2 [1.0-1.4, P=0.53] or whites OR 1.2 [1.0-1.4, P=0.9]. Patients with GERD who had public insurance such as Medicare OR 0.3 [0.2-0.31, P < 0.001] or Medicaid OR 0.4 [0.4-0.48, P< 0.001] had reduced risk of COVID-19 diagnosis compared to the uninsured. Conclusion: In GERD patients, COVID-19 diagnosis was highest among African Americans and PPI users. Female Hispanics were least likely to be diagnosed with COVID-19. Insurance status may indirectly influence susceptibility to COVID-19.Figure 1.: Multivariable regression analysis. A forest plot of gender differences for odds of COVID-19 diagnosis in patients with gastroesophageal reflux disease (GERD) based on race/ethnicity and public insurance type. Abbreviation: PPI, proton pump inhibitors.Table 1.: Baseline Characteristics of Patients with Gastroesophageal Reflux Disease (GERD) Included in the Study. Abbreviations: PPI, proton pump inhibitors; CI, confidence interval.