Division of Digestive and Liver Disease, Columbia University, New York, NY 10032, USA.
Dig Dis Sci. 2010 Jul;55(7):2014-20. doi: 10.1007/s10620-009-1079-7. Epub 2010 Jan 16.
Suboptimal bowel preparation prior to colonoscopy is a common occurrence, with a deleterious impact on colonoscopy effectiveness. Established risk factors for suboptimal bowel preparation have been proposed, but social factors, such as socioeconomic status and marital status, have not been investigated.
The aim of this study was to evaluate sociodemographic factors, including insurance status and marital status, as predictive of suboptimal preparation.
We analyzed a database of 12,430 consecutive colonoscopies during a 28-month period at Columbia University Medical Center. We collected the following variables: age, gender, indication for colonoscopy, location (inpatient vs. outpatient), race, marital status, and Medicaid status. Preparation quality was recorded and dichotomized as optimal or suboptimal. We employed multivariate regression to determine independent risk factors for suboptimal bowel preparation.
Among the 10,921 examinations in which bowel preparation was recorded, suboptimal preparation occurred in 34% of Medicaid patients versus 18% of non-Medicaid patients (P < 0.0001); this remained significant in the multivariate analysis (odds ratio (OR) 1.84, 95% CI 1.61-2.11). Married patients had decreased rates of suboptimal preparation (OR 0.89, 95% CI 0.80-0.98). Other variables associated with suboptimal preparation included increased age (OR per 10 years 1.09, 95% CI 1.05-1.14), male gender (OR 1.44, 95% CI 1.31-1.59), inpatient status (OR 1.51, 95% CI 1.26-1.80), and later time of day (OR 1.89, 95% CI 1.71-2.09).
Unmarried status and Medicaid status are predictive of suboptimal bowel preparation. Future studies are warranted to identify how these social conditions predict bowel preparation quality and to implement interventions to optimize bowel preparation in vulnerable populations.
结肠镜检查前肠道准备不充分是一种常见现象，会对结肠镜检查的效果产生有害影响。已经提出了肠道准备不充分的既定危险因素，但社会因素，如社会经济地位和婚姻状况，尚未得到研究。
本研究旨在评估社会人口统计学因素，包括保险状况和婚姻状况，作为预测肠道准备不充分的指标。
我们分析了哥伦比亚大学医学中心 28 个月期间连续 12430 例结肠镜检查的数据库。我们收集了以下变量：年龄、性别、结肠镜检查指征、地点（住院或门诊）、种族、婚姻状况和医疗补助状况。记录肠道准备质量并分为最佳或不充分。我们采用多元回归确定肠道准备不充分的独立危险因素。
在记录肠道准备情况的 10921 次检查中，医疗补助患者中肠道准备不充分的发生率为 34%，而非医疗补助患者为 18%（P<0.0001）；在多变量分析中这仍然具有显著性（比值比（OR）1.84，95%置信区间（CI）1.61-2.11）。已婚患者肠道准备不充分的发生率较低（OR 0.89，95% CI 0.80-0.98）。其他与肠道准备不充分相关的因素包括年龄增加（每增加 10 岁，OR 1.09，95% CI 1.05-1.14）、男性（OR 1.44，95% CI 1.31-1.59）、住院状态（OR 1.51，95% CI 1.26-1.80）和较晚的时间（OR 1.89，95% CI 1.71-2.09）。
未婚状态和医疗补助状况是肠道准备不充分的预测指标。需要进一步研究以确定这些社会条件如何预测肠道准备质量，并实施干预措施，以优化弱势群体的肠道准备。
