Risk factors for Barrett's esophagus compared between African Americans and non-Hispanic Whites

Am J Gastroenterol. 2014 Dec;109(12):1870-80. doi: 10.1038/ajg.2014.351. Epub 2014 Nov 25.


Objectives: Esophageal adenocarcinoma is more common among non-Hispanic Whites (NHWs) than African Americans (AAs). It is unclear whether its precursor, Barrett's esophagus (BE), is also less common among AAs, and whether differences in risk factor profiles explain the racial disparity.

Methods: Data were from a case-control study among eligible Veterans Affairs patients scheduled for an upper endoscopy, and a sample identified from primary care clinics. Participants completed a questionnaire on sociodemographic and clinical factors and underwent a study esophagogastroduodenoscopy. We calculated race-specific BE prevalence rates and used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for BE.

Results: There were 301 BE cases and 1,651 controls. BE prevalence was significantly higher among NHWs than AAs (21.3 vs. 5.0%; P<0.001). NHWs were more likely than AAs to be male, have a high waist-to-hip ratio (WHR), hiatal hernia, and use proton-pump inhibitors (PPIs), but less likely to have Helicobacter pylori (P<0.001). Among cases, NHWs were more likely to have long-segment BE and dysplasia than AAs. Independent BE risk factors for AAs included a hiatus hernia ≥3 cm (OR 4.12; 95% CI, 1.57-10.81) and a history of gastroesophageal reflux disease or PPI use (OR, 3.70; 95% CI, 1.40-9.78), whereas high WHR (OR, 2.82; 95% CI, 1.41-5.63), hiatus hernia ≥3 cm (OR, 4.95; 95% CI, 3.05-8.03), PPI use (OR, 1.88; 95% CI, 1.33-2.66), and H. pylori (OR, 0.64; 95% CI, 0.41-0.99) were statistically significantly associated with BE risk for NHWs. Among all cases and controls, race was a risk factor for BE, independent of other BE risk factors (OR for AAs, 0.26; 95% CI, 0.17-0.38).

Conclusions: Among veterans, the prevalence of BE was lower in AAs compared with NHWs. This disparity was not accounted for by differences in risk estimates or prevalence of risk factors between NHWs and AAs.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • African Americans / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Barrett Esophagus / epidemiology
  • Barrett Esophagus / ethnology*
  • Barrett Esophagus / pathology
  • Endoscopy, Digestive System
  • Female
  • Gastroesophageal Reflux / drug therapy
  • Gastroesophageal Reflux / epidemiology
  • Gastroesophageal Reflux / ethnology*
  • Helicobacter Infections / epidemiology
  • Helicobacter Infections / ethnology*
  • Helicobacter pylori
  • Hernia, Hiatal / epidemiology
  • Hernia, Hiatal / ethnology*
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Overweight / epidemiology
  • Overweight / ethnology*
  • Precancerous Conditions / epidemiology
  • Precancerous Conditions / ethnology*
  • Precancerous Conditions / pathology
  • Proton Pump Inhibitors / therapeutic use
  • Risk Factors
  • Sex Factors
  • Smoking / epidemiology
  • Smoking / ethnology
  • United States / epidemiology
  • Veterans / statistics & numerical data
  • Waist-Hip Ratio / statistics & numerical data
  • Whites / statistics & numerical data*


  • Proton Pump Inhibitors