Original article
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Lorenz Curves and Gini Coefficient Analyses Indicate Inefficiencies in Esophageal Adenocarcinoma Screening

https://doi.org/10.1016/j.cgh.2018.05.002Get rights and content

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Methods

Lorenz curves and Gini coefficients were constructed for 3 strategies: (1) perfect compliance2 and (2) current compliance to using only symptomatic gastroesophageal reflux disease (GERD) to triage patients for endoscopic EAC screening2; and (3) potential risk stratification using 5 risk factors including race, sex, smoking status (never smoker vs ever smoker), obesity (body mass index categories with normal, overweight, and obese), and GERD symptoms that resulted in 48 subgroups. For the third

Results

Figure 1A presents Lorenz curves with cumulative EAC cases on the x-axis and cumulative US population on the y-axis. First, we depicted the Lorenz curves that are consistent with the previously recommended strategy targeting the presence of GERD symptoms as the primary risk factor to triage patients for endoscopic screening. The yellow curve represents perfect adherence with a Gini coefficient of 0.39, where 17.5% of the population with symptomatic GERD can be used to identify approximately 56%

Discussion

Although there is no correct or established cutoff, one intuitive or visual inflection point is where 80% of patients who will develop EAC are identified, achieved by targeting 29% of the population (shaded in darker green). To identify 90% of EAC cases would require targeting more than 42% of the population.

Our Lorenz curve and Gini coefficient calculations not only highlight the inefficiency of current practice of GERD-only centric strategy, but also exhibit the potential synergic effects

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Conflicts of interest The authors disclose no conflicts.

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