S897 Socioeconomic and Insurance-Related Disparities in Hospital Admissions and Mortality for Esophageal Varices: Analysis of National Inpatient Data

Introduction: Esophageal varices are a serious complication of portal hypertension and chronic liver disease, often requiring hospitalization and associated with increased mortality. Socioeconomic factors and insurance status may influence the frequency of hospitalization and outcomes. This study examines the effects of income and payer type on hospital admission patterns and inpatient mortality for patients with esophageal varices through a national cohort analysis. Methods: Data were extracted from the National Inpatient Sample (NIS) database from 2019 to 2021. Patients admitted with a primary diagnosis of esophageal varices were identified. Analyses included stratification by income quartile and primary payer status. Income was categorized into 4 quartiles: quartile 1 (≤$43,000), quartile 2 ($44,000-$55,900), quartile 3 ($56,000-$73,000), and quartile 4 (≥$74,000). Insurance coverage was categorized into Medicare, Medicaid, private insurance, and self-pay. Multivariate logistic was used to adjust for confounders. The primary outcome was inpatient mortality. Stata software was utilized for statistical analysis. Results: Among the 30,889 patients identified with a primary diagnosis of esophageal varices, those from the lowest income quartile (≤$43,000) accounted for the largest proportion of hospitalization (32.8%), followed by quartile 2 (26.7%), quartile 3 (23.7%), and quartile 4 (16.7%). In terms of payer status, Medicare was the most common (37.9%), followed by Medicaid (25.7%), private insurance (24.5%), and self-pay (7.8%). Inpatient mortality rates varied significantly based on insurance type (P = 0.0067). Patients with self-pay status had the highest mortality (11.4%), followed by Medicaid (9.7%), Medicare (7.9%), and private insurance (7.1%). Conclusion: This study highlights clear disparities in admission patterns and mortality outcomes among patients with esophageal varices. Individuals from lower-income quartiles were more frequently hospitalized and those without insurance (self-pay) or with Medicaid experienced higher inpatient mortality. These findings suggest that socioeconomic disadvantage and limited insurance coverage are associated with worse outcomes in these populations. Interventions addressing access to preventative care along with earlier disease management for these vulnerable groups may help reduce these disparities.