TY - JOUR
T1 - The impact of socioeconomic status on presentation and treatment of diverticular disease
AU - Csikesz, Nicholas G.
AU - Singla, Anand
AU - Simons, Jessica P.
AU - Tseng, Jennifer F.
AU - Shah, Shimul A.
N1 - Funding Information:
Acknowledgment This work was supported by the American Society of Transplant Surgeons Faculty Development Award and Worcester Foundation for Biomedical Research (SAS).
Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2009
Y1 - 2009
N2 - Introduction Diverticular disease is a common medical problem, but it is unknown if lower socioeconomic status (SES) affects patient outcomes in diverticular disease. Material and methods The New York (NY) State Inpatient Database was used to query 8,117 cases of diverticular disease occurring in patients aged 65-85 in 2006. Race and SES were assessed by creating a composite score based on race, primary insurance payer, and median income bracket. Results Primary outcomes were differences in disease presentation, use of elective surgery, complication rates when surgery was performed, and overall mortality and length of stay. Patients of lower SES were younger, more likely to be female, to have multiple co-morbid conditions, to present as emergent/urgent admissions, and to present with diverticulitis complicated by hemorrhage (p<0.0001). Discussion Overall, patients of low SES were less likely to receive surgical intervention, while rates of surgery were similar in elective cases. When surgery was performed, patients of lower SES had similar complication rates (25.4% vs. 20.2%, p=0.06)andhigheroverallmortality (9.0% vs.4.4%, p=0.003). Conclusion Patients of low SES who are admitted with diverticular disease have an increased likelihood to present emergently, have worse disease on admission, and are less likely to receive surgery.
AB - Introduction Diverticular disease is a common medical problem, but it is unknown if lower socioeconomic status (SES) affects patient outcomes in diverticular disease. Material and methods The New York (NY) State Inpatient Database was used to query 8,117 cases of diverticular disease occurring in patients aged 65-85 in 2006. Race and SES were assessed by creating a composite score based on race, primary insurance payer, and median income bracket. Results Primary outcomes were differences in disease presentation, use of elective surgery, complication rates when surgery was performed, and overall mortality and length of stay. Patients of lower SES were younger, more likely to be female, to have multiple co-morbid conditions, to present as emergent/urgent admissions, and to present with diverticulitis complicated by hemorrhage (p<0.0001). Discussion Overall, patients of low SES were less likely to receive surgical intervention, while rates of surgery were similar in elective cases. When surgery was performed, patients of lower SES had similar complication rates (25.4% vs. 20.2%, p=0.06)andhigheroverallmortality (9.0% vs.4.4%, p=0.003). Conclusion Patients of low SES who are admitted with diverticular disease have an increased likelihood to present emergently, have worse disease on admission, and are less likely to receive surgery.
KW - Access
KW - Disparities
KW - Diverticulitis
KW - NIS
KW - Propensity scores
KW - Race
KW - Socioeconomic status
KW - Surgery
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U2 - 10.1007/s11605-009-1031-3
DO - 10.1007/s11605-009-1031-3
M3 - Article
C2 - 19760302
AN - SCOPUS:77953016080
SN - 1091-255X
VL - 13
SP - 1993
EP - 2002
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 11
ER -