Socioeconomic disparities in ostomy reversal among older adults with diverticulitis are more substantial among non-Hispanic Black patients.
Black or African American
Aged
Aged, 80 and over
Cohort Studies
Colectomy
/ economics
Diverticulitis, Colonic
/ economics
Female
Healthcare Disparities
/ economics
Humans
Male
Medicare
/ economics
Morbidity
/ trends
Ostomy
/ economics
Retrospective Studies
Social Class
Socioeconomic Factors
United States
/ epidemiology
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
received:
05
12
2020
revised:
01
03
2021
accepted:
22
03
2021
pubmed:
3
5
2021
medline:
26
11
2021
entrez:
2
5
2021
Statut:
ppublish
Résumé
While ostomies for diverticulitis are often intended to be temporary, ostomy reversal rates can be as low as 46%. There are few comprehensive studies evaluating the effects of socioeconomic status as a disparity in ostomy reversal. We hypothesized that among the elderly Medicare population undergoing partial colectomy for diverticulitis, lower socioeconomic status would be associated with reduced reversal rates. Retrospective cohort study using a 20% representative sample of Medicare beneficiaries >65 years old with diverticulitis who received ostomies between January 1, 2010, to December 31, 2017. We evaluated the effect of neighborhood socioeconomic status, measured by the Social Deprivation Index, on ostomy reversal within 1 year. Secondary outcomes were complications and mortality. Of 10,572 patients, ostomy reversals ranged from 21.2% (low socioeconomic status) to 29.8% (highest socioeconomic status), with a shorter time to reversal among higher socioeconomic status groups. Patients with low socioeconomic status were less likely to have their ostomies reversed, compared with the highest socioeconomic status group (hazard ratio 0.83, 95% confidence interval 0.74-0.93) and were more likely to die (hazard ratio 1.21, 95% confidence interval 1.10-1.33). When stratified by race/ethnicity and socioeconomic status, non-Hispanic White patients at every socioeconomic status had a higher reversal rate than non-Hispanic Black patients (White patients 32.0%-24.8% vs Black patients 19.6%-14.7%). Socioeconomic status appeared to have a higher relative impact among non-Hispanic Black patients. Among Medicare diverticulitis patients, ostomy reversal rates are low. Patients with lower socioeconomic status are less likely to undergo stoma reversal and are more likely to die; Black patients are least likely to have an ostomy reversal.
Sections du résumé
BACKGROUND
While ostomies for diverticulitis are often intended to be temporary, ostomy reversal rates can be as low as 46%. There are few comprehensive studies evaluating the effects of socioeconomic status as a disparity in ostomy reversal. We hypothesized that among the elderly Medicare population undergoing partial colectomy for diverticulitis, lower socioeconomic status would be associated with reduced reversal rates.
METHODS
Retrospective cohort study using a 20% representative sample of Medicare beneficiaries >65 years old with diverticulitis who received ostomies between January 1, 2010, to December 31, 2017. We evaluated the effect of neighborhood socioeconomic status, measured by the Social Deprivation Index, on ostomy reversal within 1 year. Secondary outcomes were complications and mortality.
RESULTS
Of 10,572 patients, ostomy reversals ranged from 21.2% (low socioeconomic status) to 29.8% (highest socioeconomic status), with a shorter time to reversal among higher socioeconomic status groups. Patients with low socioeconomic status were less likely to have their ostomies reversed, compared with the highest socioeconomic status group (hazard ratio 0.83, 95% confidence interval 0.74-0.93) and were more likely to die (hazard ratio 1.21, 95% confidence interval 1.10-1.33). When stratified by race/ethnicity and socioeconomic status, non-Hispanic White patients at every socioeconomic status had a higher reversal rate than non-Hispanic Black patients (White patients 32.0%-24.8% vs Black patients 19.6%-14.7%). Socioeconomic status appeared to have a higher relative impact among non-Hispanic Black patients.
CONCLUSION
Among Medicare diverticulitis patients, ostomy reversal rates are low. Patients with lower socioeconomic status are less likely to undergo stoma reversal and are more likely to die; Black patients are least likely to have an ostomy reversal.
Identifiants
pubmed: 33933283
pii: S0039-6060(21)00297-X
doi: 10.1016/j.surg.2021.03.050
pmc: PMC8490310
mid: NIHMS1700782
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Intramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1039-1046Subventions
Organisme : Intramural NIH HHS
ID : Z99 MD999999
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
Références
Clin Epidemiol. 2017 May 09;9:267-277
pubmed: 28533698
J Clin Oncol. 2009 Aug 20;27(24):3945-50
pubmed: 19470926
Am J Surg. 2016 Apr;211(4):710-5
pubmed: 26852146
JAMA Surg. 2014 Mar;149(3):292-303
pubmed: 24430164
J Clin Nurs. 2019 May;28(9-10):1728-1736
pubmed: 30589480
J Am Coll Surg. 2014 Jul;219(1):70-77.e1
pubmed: 24862884
Ann Surg. 2007 Dec;246(6):1083-91
pubmed: 18043114
J Surg Res. 2013 Jul;183(1):238-45
pubmed: 23298948
JAMA Intern Med. 2016 Apr;176(4):484-93
pubmed: 26954564
J Am Coll Surg. 2009 Jun;208(6):1017-22
pubmed: 19476885
Am J Public Health. 1997 Nov;87(11):1773-8
pubmed: 9366634
Surg Endosc. 2008 Oct;22(10):2168-70
pubmed: 18626708
Dis Colon Rectum. 2018 May;61(5):586-592
pubmed: 29630003
SSM Popul Health. 2019 Aug 28;9:100477
pubmed: 31517017
Int J Colorectal Dis. 2018 May;33(5):593-600
pubmed: 29508050
Mayo Clin Proc. 2018 Sep;93(9):1256-1265
pubmed: 30193674
Cancer. 2009 Sep 1;115(17):3979-90
pubmed: 19514091
J Clin Oncol. 2006 Jan 20;24(3):413-8
pubmed: 16365180
J Gerontol A Biol Sci Med Sci. 2021 Jun 14;76(7):1316-1317
pubmed: 32529241
J Clin Epidemiol. 1992 Jun;45(6):613-9
pubmed: 1607900
Ann R Coll Surg Engl. 2018 Apr;100(4):301-307
pubmed: 29484943
Clin Gastroenterol Hepatol. 2013 Dec;11(12):1609-13
pubmed: 23856358
Health Serv Res. 2013 Apr;48(2 Pt 1):539-59
pubmed: 22816561
J Gastrointest Surg. 2017 Nov;21(11):1865-1878
pubmed: 28932946
Int J Colorectal Dis. 2009 Oct;24(10):1219-25
pubmed: 19499234
J Gastrointest Surg. 2018 Feb;22(2):250-258
pubmed: 28755086
J Vasc Surg. 2008 Jun;47(6):1172-80
pubmed: 18407451
Int J Colorectal Dis. 2013 Apr;28(4):447-57
pubmed: 23242271
World J Gastrointest Surg. 2014 Sep 27;6(9):169-74
pubmed: 25276286
J Am Coll Surg. 2017 Dec;225(6):798-805
pubmed: 28943323
JBI Database System Rev Implement Rep. 2016 Feb;14(2):106-73
pubmed: 27536797
JAMA Surg. 2019 Mar 1;154(3):218-224
pubmed: 30476948
Dis Colon Rectum. 2012 Dec;55(12):1266-72
pubmed: 23135585
J Am Coll Surg. 2013 Mar;216(3):482-92.e12
pubmed: 23318117
Tech Coloproctol. 2019 May;23(5):445-451
pubmed: 31062196
Spine (Phila Pa 1976). 2009 Aug 15;34(18):1956-62
pubmed: 19652634