Sex-Based Disparities in the Use and Results of Gastrointestinal Procedures for Workup of Anemia

Background: Iron deficiency is a common cause of anemia, and etiologies differ by sex. Endoscopic procedures are often utilized to search for a source of gastrointestinal blood loss in patients with iron deficiency, but sex-based differences in patterns of workup have not been well characterized.
Methods: We performed a retrospective review of all patients at Mayo Clinic who underwent esophagogastroduodenoscopy (EGD), colonoscopy, or both between July 1, 2014 and June 30, 2015 for an indication of “anemia” or “iron deficiency anemia” and analyzed the data for evidence of sex-based differences in procedure outcomes.
Results: 999 procedures were performed; 455 (46%) procedures were performed on men and 544 (54%) on women. Median age was 68 years in men (range 19-94) and 64 years in women (range 18-94), P<0.01. 365 (37%) procedures identified a probable benign source of bleeding, 54 (5%) identified a probable malignant source, and 580 (58%) had no findings consistent with a bleeding source. Procedures performed on men were more likely to identify a source of bleeding (48% versus 37%, P<0.01), primarily EGDs which were significantly more likely to identify a bleeding source in men (59% versus 37%, P<0.01).
Conclusion: There are sex-based variations in the utilization and findings of EGD and colonoscopy used for workup of anemia. A source of bleeding is more likely to be identified in men, particularly in the case of EGD. Clinicians should be made aware of these variations and quality improvement programs may be helpful to reduce non-clinically indicated practice variations.