Health risk factors in different educational groups and their association to Barrett's esophagus.

Abstract

Introduction: General health risk factors may vary significantly across different education groups. These disparities in lifestyle choices can contribute to the development of chronic conditions, including gastrointestinal disorders. Barrett's esophagus (BE), a premalignant condition associated with increased risk of esophageal cancer, may be influenced by these social determinants of health. This work explores how education status shapes the prevalence of BE, considering how key health risk factors in different education groups impact the development of the condition.

Methods: We analyzed data from a cohort of 5160 Austrian individuals who underwent esophagogastroduodenoscopy (EGD) and screening colonoscopy. Participants were categorized into three education groups: low (n = 1933), medium (n = 2780), and high (n = 447). The distribution of risk factors across education groups was observed and the prevalence of BE (including any BE and dysplastic BE) was assessed using univariate and multivariable regression analyses, adjusting for potential confounders such as age, sex, metabolic syndrome, smoking, alcohol consumption, reflux severity, hiatal hernia and proton pump inhibitor intake.

Results: General health risk factors, such as metabolic syndrome, alcohol consumption, gastroesophageal reflux and smoking are more prevalent in lower education groups, contributing to a higher burden of chronic diseases. The prevalence of histologically confirmed Barrett's esophagus was low across all education levels, showing no significant differences (p = 0.90). Nondysplastic BE was present in 1% of participants, with similar rates across the low, medium and high education groups (1% each). Only one case of high-grade dysplasia (HGD) was found in the medium education group. In the unadjusted analysis no significant link was found between education level and Barrett's esophagus. Compared to those with lower education, the odds were 1.25 (95% confidence interval, CI: 0.71-2.19, p = 0.443) for medium and 0.91 (95% CI: 0.31-2.69, p = 0.864) for high education. In the fully controlled model, accounting for age, sex, metabolic syndrome, smoking, alcohol consumption, reflux severity, hiatal hernia, and proton pump inhibitor use, the association remained nonsignificant, with odds ratios of 1.15 (95% CI: 0.55-2.40, p = 0.719) for medium and 1.01 (95% CI: 0.30-3.36, p = 0.986) for high education.

Conclusion: Our study indicates that education level is associated with the distribution of general risk factors, but it is not a key factor in Barrett's esophagus risk in an asymptomatic screening population. Although education impacts health outcomes in many conditions, its influence on BE seems minimal. Future research should explore broader socioeconomic factors, such as income, occupation and healthcare access for a better understanding of the BE risk and detection disparities.