Introduction: Helicobacter pylori is a prevalent infection in the United States, with a lifetime prevalence of about 33%. H. pylori is a strong risk factor for dyspepsia, peptic ulcer disease, and gastric adenocarcinoma; ensuring prompt treatment and confirmed eradication of this infection is imperative. Unfortunately, H. pylori disproportionately affects people of lower socioeconomic status. Prior studies have shown that race, gender, income, and rural habitation correlate with higher risk of eradication failure. This study aimed to assess socioeconomic, demographic, and clinical barriers to care for patients with H. pylori in a large safety-net hospital. Methods: A retrospective chart review was conducted on 694 patients who were at least 18 years old with biopsy proven H. pylori infection between November 2015 and May 2021. Demographic data, endoscopy indications and findings, appointment follow up, treatment regimens and durations, and characteristics of eradication testing were collected. The data were analyzed using a combination of the Pearson chi-squared test, T-test, and logistic regressions to assess the influence of various variables on: (1) ordering of eradication testing, (2) completion of eradication testing (if ordered), and (3) achievement of eradication. Results: Overall, eradication testing was ordered for 50.5% of patients. Of patients who had eradication testing ordered, 66.8% completed testing. Of patients who completed testing, 85.6% achieved successful eradication. Gender, endoscopy setting, patient follow-up, and treatment type were statistically significant factors influencing both if eradication testing was ordered and if completed by the patient (all P < 0.05; Table). Preferred language, Gini index, days from endoscopy to follow-up, and scheduled follow-up by a provider were significantly associated with completion of eradication testing by the patient (all P < 0.05). There were no statistically significant factors impacting successful eradication. Conclusion: Ideally, eradication testing should be ordered and completed for every patient treated for H. pylori. Given that testing was ordered for just above half of patients, there is significant room for improvement in the process of ordering eradication testing for patients in vulnerable populations. The results of this study make imperative the need to address H. pylori treatment disparities, particularly, in safety-net healthcare systems in order to improve clinical outcomes. Table 1. - Analyses of Various Demographic, Socioeconomic, and Clinical Factors Influencing Provider Ordering of H. pylori Eradication Testing Factors Eradication Not Ordered (N= 336) Eradication Ordered (N= 343) P Value Age in years, mean (SD) 56.25 (13.12) 55.58 (12.85) 0.501 Gender, N (%) 0.006 Female 141 (42) 180 (52) Male 195 (58) 163 (48) Race, N (%) 0.087 Asian 6 (2) 16 (5) Black/African American 293 (87) 279 (81) Hispanic 29 (9) 35 (10) White 8 (2) 13 (4) Preferred Language, N (%) 0.002 English 307 (91) 287 (84) Non-English 29 (9) 56 (16) Insurance Type, N (%) 0.468 Private 52 (15) 65 (19) Public 166 (50) 159 (46) Uninsured 116 (35) 118 (35) Distance from Hospital in miles, mean (SD) 15.94 (41.12) 18.45 (119.06) 0.716 Median Income, mean (SD) 49,317.70 (17,756.49) 51,356.59 (16,811.41) 0.129 Mean Income, mean (SD) 68,280.98 (23,828.35) 69,917.31 (23,620.25) 0.374 Gini Index, mean (SD) 0.471 (0.05) 0.461 (0.5) 0.011 Endoscopy Setting, N (%) < 0.001 Inpatient 173 (51) 100 (29) Outpatient 163 (49) 243 (71) Indications of Endoscopy, N (%) 0.608 Diagnostic 309 (92) 319 (93) Screening/Surveillance 27 (8) 24 (7) Gastric & Duodenal Mucosal Findings, N (%) 0.130 Erosions/Gastritis/Duodenitis 132 (39) 135 (39) Ulcer(s) 121 (36) 99 (29) Polyp/Mass 13 (4) 21 (6) Other 7 (2) 5 (2) Normal 63 (19) 83 (24) Who Informed Patient of H Pylori Results, N (%) 0.497 GI provider 234 (70) 247 (72) Non-GI provider 102 (30) 96 (28) Days from Endoscopy to Patient Informed, mean (SD) 18.76 (14.95) 19.06 (16.60) 0.803 Follow-up Scheduled by Provider, N (%) < 0.001 Yes 181 (54) 295 (86) No 155 (46) 48 (14) Patient Showed up to Follow-up, N (%) < 0.001 Yes 109 (60) 264 (90) No 72 (40) 30 (10) Days from Endoscopy to Follow Up, mean (SD) 50.87 (42.21) 85.45 (92.17) < 0.001 Days from Endoscopy to Treatment Order, mean (SD) 19.50 (16.28) 27.04 (95.06) 0.152 Treatment Type, N (%) < 0.001 Quadruple Therapy 189 (56) 246 (72) Triple Therapy 147 (44) 96 (28) Treatment Duration, N (%) 0.046 7-10 Days 138 (41) 167 (49) 14 Days 198 (59) 176 (51)