S2113 Unequal Eradication: Patient and Provider Factors Associated with H. pylori Treatment Failure

Introduction: Successful eradication is key to reducing the burden of Helicobacter pylori. This study characterized patient and provider characteristics related to eradication failure within a diverse U.S. integrated health system. Methods: We conducted a retrospective cohort study of 30,390 Kaiser Permanente Southern California adult members between 2008-2023 who were diagnosed with H. pylori via stool antigen test, received treatment, and had follow-up stool antigen tests within 1 year of diagnosis. We defined unsuccessful eradication as a positive confirmatory stool antigen test within 1 year of diagnosis. Patients without follow-up testing were excluded from the study. We fit a generalized estimating equations (GEE) model to evaluate the relationship between unsuccessful eradication and patient characteristics (e.g., sociodemographics, used interpreter) and provider characteristics (e.g., age, sex, specialty). Results: Most patients were <50 years old (52%), female (66%), and Hispanic (66%), followed by White (12%), Asian (11%), and Black (8%). Most spoke English as their primary language (72%) and did not require an interpreter (77%). For most patients, their provider was <50 years old (75%), female (55%), and a primary care physician (97%). The overall rate of successful eradication was 73%. Hispanic patients were more likely to have unsuccessful eradication than White patients (White vs Hispanic, odds ration [OR] = 0.78, confidence interval [CI] 0.71–0.85, P < .001) and Black patients (Black vs Hispanic, OR = 0.87, CI 0.78–0.97, P = 0.013). Compared to patients from least deprived neighborhoods, patients from more deprived and most deprived neighborhoods had higher odds of unsuccessful H. pylori eradication (more deprived vs least deprived, OR = 1.12, CI 1.02–1.24, P = 0.021; most deprived vs least deprived, OR = 1.13, CI 1.02–1.26, P = 0.022). Patients whose provider was a primary care physician had higher odds of unsuccessful eradication compared to those whose provider was a gastroenterologist (OR = 1.38, CI 1.06–1.79, P = .016). Conclusion: Our study identifies racial disparities in H. pylori eradication among Hispanic patients, highlights neighborhood deprivation as a crucial factor in successful eradication, and spotlights a difference in treatment outcomes between provider specialties indicating an area for potential support and improvement in primary care settings.