S868 Shifting Gender and Racial Trends in Barrett’s Esophagus: A 20-Year Analysis (2005-2024)

Introduction: Barrett’s esophagus (BE) has historically been more prevalent in men; however, emerging evidence suggests a rising burden among women. We aimed to evaluate 20-year (2005-2024) trends in BE diagnoses with a focus on gender and racial/ethnic distribution among female patients. Methods: We conducted a retrospective analysis of all Barrett’s esophagus (BE) cases from 2005 to 2024 using the TriNetX Research Network, a large federated electronic health record database. Patient gender and self-reported race/ethnicity were recorded annually. Temporal trends in the proportion of female vs male patients and in the racial/ethnic composition of female BE patients were evaluated. The Cochran-Armitage trend test was used to assess linear trends over time, with a P-value < 0.05 considered statistically significant. Results: Men consistently comprised the majority of BE diagnoses; however, their representation declined from 61.4% in 2005 to 56.2% in 2024, while female representation rose from 38.6% to 43.8%, a net gain of 5.2 percentage points. This reflects an 8.5% relative decrease in male representation and a 13.5% increase among women. On average, men accounted for 58.1% and women for 41.9% of BE diagnoses after excluding patients with unknown gender. The Cochran-Armitage trend test confirmed a significant shift in sex distribution over time (P < 0.001), supported by Z-scores (female Z = 10.933; male Z = -10.053). Among female BE patients, White women constituted the majority (mean 83.6%), followed by, Black/African American (3.9%), and Asian (2.1%). Statistically significant increases were observed in the proportions of White (Z = 10.489, P < 0.001), Black (Z = 7.324, P < 0.001), and Asian (Z = 3.081, P = 0.002) women. In contrast, Native Hawaiian/Pacific Islander (Z = -11.365, P < 0.001) and the unknown race (Z = -22.050, P < 0.001) proportions declined significantly. No significant trend was observed among American Indian/Alaska Native women (Z = 1.56, P = 0.118). Conclusion: This 20-year trend analysis reveals a steady rise in BE diagnoses among women, particularly across White, Black, and Asian populations, signaling a shift from traditional male-dominated patterns. These findings underscore the need to re-evaluate screening strategies, ensuring equitable identification and surveillance of BE in women across diverse racial groups.