S1364 Racial Disparities in Upper Gastrointestinal Bleeding Among People Living With HIV in the United States

Introduction: In the United States, African Americans (AA) accounted for approximately 40% of newly diagnosed HIV cases and had higher mortality than American Whites (AW) (20.1 vs 3.1 per 100,000). Upper gastrointestinal bleeding (UGIB), though relatively rare with a prevalence of 1–14%, remains a significant concern. A gap exists in the impact of racial differences in HIV with UGIB. We aimed to study racial disparities in mortality in people living with HIV (PLWH) with UGIB. Methods: We conducted a retrospective analysis using the National Inpatient Sample (2016–2021) to identify PLWH adults (≥18 years) with UGIB. ICU-level care was identified by the presence of shock or the need for invasive mechanical ventilation and/or renal replacement therapy. We performed multivariate regression by adjusting for sociodemographic factors and comorbidities, and reported it as adjusted odds ratios (aOR) and adjusted mean differences (aMD). A P ≤ 0.05 was considered significant. Results: Among 6,923 PLWH with UGIB requiring ICU-level care, mortality was higher in AA than AW (37.1% vs 29.9%). AA had a higher mortality risk than AW (aOR 1.5; 95% CI, 1.1-2.1; P < 0.05). AA were associated with no difference in hospital charges (aMD -$19,347.5; 95% CI, -84,293.1 to 45,598.1; P > 0.05), or length of stay (aMD 2.0 days; 95% CI, -2.1 to 6.0; P > 0.05) than AW. In those with variceal bleeding, AA had increased mortality risk than AW (aOR 1.6, 95% CI 1.1-2.3, P = 0.01). In AA who underwent endoscopy, the mortality risk remained higher compared to AW (aOR 1.6, 95% CI 0.8-3.1, P = 0.1). In AA patients who underwent early endoscopy (<24 hours from admission), unadjusted mortality was lower than in AW patients (41.7% vs 45.8%, P < 0.05), but the difference was not significant after adjustment (P > 0.05). The mortality between the 2 cohorts did not vary with radical embolization and variceal ligation (P > 0.05). On analyzing the predictors of mortality in AA, variceal GI bleed, solid malignancy, acute coronary syndrome, acute kidney injury, sepsis, pancytopenia, and invasive ventilation were associated with higher mortality (P ≤ 0.05). Conclusion: In PLWH with upper gastrointestinal bleeding, African American patients had higher mortality than American White patients. In this population, interventions to manage gastrointestinal bleeding should be validated through prospective studies. Targeted strategies to improve healthcare access and a multidisciplinary approach may help enhance outcomes.