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Digestive Diseases and Sciences

, Volume 61, Issue 6, pp 1669–1676 | Cite as

Socioeconomic Inequalities in the Utilization of Colorectal Stents for the Treatment of Malignant Bowel Obstruction

  • Philip N. Okafor
  • Derrick J. Stobaugh
  • Louis M. Wong Kee Song
  • Paul J. Limburg
  • Jayant A. Talwalkar
Original Article

Abstract

Background

Colorectal stents are increasingly employed as a bridge to surgery or for palliative relief of malignant large bowel obstruction.

Aim

To explore determinants of inpatient colorectal stent utilization (CRSU).

Methods

An analysis of the 2012 National Inpatient Sample was performed. International Classification of Diseases, 9th revision, codes were used to identify discharges associated with CRSU and patient/hospital factors for inclusion in a logistic regression model.

Results

We identified 217,055 inpatient colonoscopies, approximating 1.1 million inpatient colonoscopies nationwide. Colorectal stents were placed in 1.4 % of all procedures. Across all racial groups, Medicare was the most common payer. Patients with commercial insurance had lower CRSU compared with Medicare patients [adjusted odds ratio (OR) 0.83, 95 % confidence interval (CI) 0.75–0.92]. No gender disparities were identified (OR 0.96, 95 % CI 0.89–1.03). In addition, no racial differences in CRSU existed between Caucasians versus African-Americans (OR 0.94, 95 % CI 0.83–1.06) and Caucasians versus Hispanics (OR 0.96, 95 % CI 0.83–1.1). Compared with patients living in less affluent neighborhoods, those residing in more affluent areas had higher CRSU (OR 1.65, 95 % CI 1.46–1.86). This displayed a linear relationship with the odds of CRSU increasing as household income increased. Less affluent patients also had the highest total charges and longest wait time to CRSU. CRSU was highest among patients treated in larger medical centers (OR 1.7, 95 % CI 1.51–1.93) and teaching hospitals (OR 3.9, 95 % CI 3.2–4.8).

Conclusion

Individuals from less affluent neighborhoods have lower colorectal stent utilization. This disparity is independent of race and likely related to poorer access to healthcare resources.

Keywords

Disparities Healthcare resource utilization Self-expanding metal stents Palliative endoscopy 

Abbreviations

CRSU

Colorectal stent utilization

NIS

Nationwide Inpatient Sample

Notes

Author Contributions

Philip N. Okafor involved in study concept and design, literature review, data acquisition, interpretation, and preparation of the manuscript. Derrick J. Stobaugh involved in study design, data acquisition, analysis, interpretation, and manuscript preparation. Louis M. Wong Kee Song involved in data interpretation and critical revision of manuscript for important intellectual content. Paul J. Limburg involved in data interpretation and critical revision of manuscript for important intellectual content. Jayant A. Talwalkar involved in study concept, design, critical revision of manuscript for important intellectual content and study supervision.

Compliance with ethical standards

Conflict of interest

All authors have no financial, professional, or personal conflicts to disclose.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Philip N. Okafor
    • 1
  • Derrick J. Stobaugh
    • 2
  • Louis M. Wong Kee Song
    • 1
  • Paul J. Limburg
    • 1
  • Jayant A. Talwalkar
    • 1
    • 3
  1. 1.Division of Gastroenterology and HepatologyMayo ClinicRochesterUSA
  2. 2.North Shore University Health SystemSkokieUSA
  3. 3.Division of Health Care Policy and Research, Department of Health Sciences ResearchMayo ClinicRochesterUSA

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