Acid Suppression Use Among Hispanic Adults Without Documented Reflux Disease

Background

Gastroesophageal reflux disease (GERD) is a common reason for long-term acid-suppressive therapy, yet the diagnosis is often based on symptoms rather than an objective test. As a result, what appears in the medical record may depend on how symptoms are elicited and documented. We examined whether Hispanic adults in the United States differ from non-Hispanic White adults in how often GERD is documented relative to proton pump inhibitor (PPI) use.

Methods

We analyzed adults aged 20 years or older using three national datasets. The National Health and Nutrition Examination Survey (NHANES, 2017 to March 2020) provided self-reported prescription medications with the condition each was taken for, in 9,232 adults including 1,997 Hispanic adults. The Medical Expenditure Panel Survey (MEPS, 2017 to 2023) provided both coded diagnoses and actual pharmacy fills in the same people, in 136,172 adults including 29,010 Hispanic adults. The National Ambulatory Medical Care Survey health center component (NAMCS, 2022 to 2024) provided visit-level coding across 973,087 adult visits, including 283,743 by Hispanic patients. GERD was defined by ICD-10 code K21 and treatment by any PPI. Estimates were survey-weighted, and logistic regression adjusted for age and sex.

RESULTS. Across all three datasets, Hispanic adults had lower rates of documented GERD and PPI use. In MEPS, GERD was coded in 3.10% of Hispanic adults versus 8.44% of non-Hispanic White adults (aOR 0.48, 95% CI 0.44–0.53), while PPI fills occurred in 5.17% versus 10.64% (aOR 0.65, 0.60–0.70). In NHANES, 4.16% of Hispanic adults reported a prescription for GERD versus 7.56% of White adults, and 5.75% versus 11.02% reported any PPI use (aOR 0.72, 0.53–0.96). In NAMCS, GERD was coded in 2.26% of Hispanic visits versus 5.64% of White visits (aOR 0.42, 0.29–0.61).

Among adults already filling a PPI, only 46.3% of Hispanic patients had a GERD diagnosis compared with 66.5% of White and 65.3% of Black patients. Much of this difference reflected alternative upper gastrointestinal diagnoses, particularly gastritis (13.6% vs 1.7%) and dyspepsia (9.5% vs 5.8%). Hispanic PPI users were also more likely to have no upper gastrointestinal diagnosis documented (28.3% vs 22.3%; adjusted OR 1.35, 1.17–1.56). Among patients with documented GERD, Hispanic adults remained less likely to receive a PPI (77.2% vs 83.8%; adjusted OR 0.67, 0.55–0.82). No difference was observed by nativity within Hispanic adults.

Conclusions

Hispanic adults were less likely to have GERD documented and less likely to receive PPIs than non-Hispanic White adults. Even among patients receiving PPIs, GERD was documented in fewer than half of Hispanic patients, with gastritis and dyspepsia used more often instead. These data cannot determine whether this reflects true differences in disease, diagnostic labeling, or broader documentation patterns. Hispanic adults also had fewer coded conditions overall, suggesting that some of the observed gap may reflect less complete documentation more generally. Inconsistent diagnostic labeling may affect continuity of care, medication review, and quality measurement.