Original observational study on disparate treatments for achalasia experienced by patients of white British and South Asian ethnicity

Abstract

Background: To date, there have been no studies which have considered whether treatments for achalasia are delivered equitably to different communities within a multi-ethnic society. Methods: Thirteen Trusts across England were sent Freedom of Information requests to provide information on admissions for achalasia between 2010 and 2019. Data were requested for patients of White British and South Asian ethnicity together with treatment details. Trusts which provided complete data were distinguished from those quoting numbers as <10 or <5 and results analysed separately. Treatment types were compared and correlation with deprivation sought. Results: In those Trusts which provided a detailed response there was a significant difference in the pattern of treatment between White British and South Asian patients. ( χ 2 =9.56, P<0.05). 27% of South Asian patients underwent surgical management in the form of a myotomy compared to 19% of White British patients. South Asian patients were significantly more likely to undergo a POEM procedure than White British patients (z=−3.12, P<0.01). Confirmation of a different pattern of treatment was seen in the second group of Trusts where there was a maximum of 865 admissions for treatment of achalasia. When the possible maximum number of patients treated during the decade was considered, significance was comparable ( χ 2 =7.59, P<0.05). If the minimum number of admissions of 736 was considered, then χ 2 =15.77, P<0.001. Deprivation was separately correlated with number of procedures per patient for both White British ethnicity (r s =0.733, P<0.05) and South Asian ethnicity (r s =0.686, P<0.05), indicating this was not the cause of disparate treatment. Conclusions: Patients with achalasia, who are South Asian, receive a different pattern of treatment to White British patients. They were 8% more likely to undergo a surgical form of management and 6% less likely to receive Botulinum toxin therapy. They are more likely to have a POEM procedure in inexperienced centres. In deprived communities both South Asian and White British patients are less likely to receive multiple therapies for long-term management of the disease.