Racial Disparities in People Living with Human Immunodeficiency Virus and Upper Gastrointestinal Bleeding: A Nationwide Study (2016-2021).

Background: In the United States, approximately 1.2 million people were living with HIV (PLWH) by the end of 2021, with African Americans experiencing a higher mortality rate than American Whites (20.1 per 100,000 vs 3.1 per 100,000). Upper gastrointestinal bleeding (UGIB), though uncommon (1-14%), is a serious concern. Data on UGIB among PLWH is limited. Methods: A retrospective cross-sectional analysis was conducted using the National Inpatient Sample database (2016-2021). PLWH with age ≥18 years with UGIB were identified using ICD-10 codes. Multivariate regression was used to determine mortality risk by adjusting for sociodemographic factors and comorbidities. 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 (p<0.05). Among those who underwent endoscopy, the mortality risk remained higher in AA compared to the AW (p=0.1). However, early endoscopy (<24 hours of admission) showed a lower mortality rate in AA compared to AW (41.7% vs 45.8%), but the difference was not significant after adjustment (p>0.05). In the AA cohort, comorbidities such as variceal gastrointestinal bleed, solid malignancy, acute coronary syndrome, acute kidney injury, sepsis, pancytopenia, and invasive ventilation independently increased the mortality risk (p≤0.05). Conclusions: African Americans with upper gastrointestinal bleeding were associated with increased mortality compared to American Whites. These findings underscore the need for equitable healthcare and targeted strategies to identify and address barriers in this population.