Atopic Comorbidity Burden and Inpatient Outcomes in Eosinophilic Esophagitis: A Nationwide Analysis of Hospitalizations in the United States, 2016-2022

Background: Eosinophilic esophagitis (EoE) frequently coexists with atopic conditions, but the impact of atopy on inpatient outcomes and health care utilization remains unclear. This study evaluated national trends, hospitalization characteristics, endoscopic intervention rates, and the association between atopic comorbidities and clinical outcomes among adults hospitalized with EoE from 2016–2022. Methods: A retrospective analysis was conducted using the Nationwide Inpatient Sample (NIS) 2016 to 2022. Survey-weighted descriptive statistics, trend analyses, and multivariable survey logistic and linear regression models assessed associations between atopy and inpatient outcomes, including length of stay (LOS), total hospital charges, in-hospital mortality, and need for esophageal dilation. Subgroup analyses were performed for primary diagnosis EoE encounters and sex-stratified cohorts. Results: Among 41 million U.S. adult hospitalizations, 6,561 involved EoE, 24% had at least one atopic comorbidity. Atopic patients were younger but had slightly higher comorbidity burden. Atopy prevalence, LOS, and mortality rates remained stable over time, while hospitalization costs increased by approximately $2,825 per year. In adjusted models, atopy was not associated with mortality or charges. Comorbidity burden was the strongest predictor of mortality. Atopy was independently associated with shorter LOS, with a dose-response effect with increasing atopy burden. Among all EoE hospitalizations, 32.1% underwent inpatient EGD and 5.2% required esophageal dilation; atopy was not associated with dilation risk, whereas older age, lower socioeconomic status, and geographic region were significant predictors even when EoE is the principal reason for hospitalization. Conclusion: These findings improve understanding of inpatient EoE care and point to socioeconomic and regional disparities in management.