Differences in gastroenterologists' self-reported race affect fear levels during endoscopic procedures: Results from a us national survey

ABSTRACT

Introduction: Racial disparities continue to exist during the COVID-19 pandemic. A systematic review found that Black and Hispanic patients experience disproportionate COVID-19 hospitalizations and higher morbidity and mortality. Low level evidence in that review suggested that Asians' outcomes are similar to those of non-Hispanic whites. As most practicing gastroenterologists are White, and as endoscopies are aerosolizing procedures risking viral transmission, this study evaluates differences in fear levels among gastroenterologists from different racial backgrounds. Methods: This IRB-approved multi-center cross-sectional study used a snowball sampling approach to disseminate a 42-question survey, pilot-tested for reliability and validity, to gastroenterologists across different geographic locations in the US. Fear levels during endoscopic procedures on suspected/confirmed COVID-19 patients were assessed using a 1-10 Likert scale, with 10 being the greatest fear. Fear was assessed at three points for upper and lower endoscopies first procedure, subsequent before the COVID-19 vaccine, and subsequent after the vaccine. Data was analyzed using Pearson's chi-squared, Mann-Whitney U, and Wilcoxon rank tests and significance was determined at p<0.05 Results: We analyzed 69 responses from gastroenterologists at 30 sites. Of the respondents, 39 selfidentified as white, 3 as Black, 6 as Latinx, 4 as Middle Eastern, and 17 as Asian. Due to the small sample size, non-White racial groups were combined to evaluate the impact of race on reported fear level reported by gastroenterologists who performed endoscopies during the COVID-19 pandemic. Fear levels at the six assessed points were not significantly different when comparing Asians to Whites, and when comparing Blacks and Latinx to Whites. However, Asians, Blacks, and Latinx had a higher fear level post vaccine when performing lower endoscopies compared to Whites (mean (m) 53.59, standard deviation (SD)=2.83 vs m=1.94, SD=1.083, respectively;P=0.045). Conclusion: While results can be due to chance due to the small sample size and survey response bias, our study suggests that after receiving the COVID-19 vaccine, minority endoscopists experienced greater fear than White endoscopists while performing lower endoscopies. It is possible that the disproportionate COVID-19 disease burden in Black and Hispanic communities negates the decrease in fear levels that was experienced by White endoscopists even after receiving the COVID-19 vaccine..