Department of Surgery, Weill Cornell Medical College, New York, New York, USA.
Dis Colon Rectum. 2011 May;54(5):559-65. doi: 10.1007/DCR.0b013e31820d188f.
Racial identity and health insurance have been associated with differential health care outcomes for many diseases, but not for diverticulitis. We examined the association of racial identity and insurance with admission, treatment, and mortality for patients admitted to inpatient care for acute diverticulitis.
Data on adult inpatients with nonelective diverticulitis admissions between 1985 and 2006 were extracted from the New York Statewide Planning and Cooperative Systems Database. Race categories were white non-Hispanic, black non-Hispanic, Hispanic, Asian, other race, and unknown race. A multivariable logistic regression model adjusted for insurance, year, patient factors, community factors, and hospital factors was used to examine the association of racial identity and insurance with presentation, treatment, and mortality. Five outcomes were considered: 1) admission via the emergency department, 2) complicated disease presentation, 3) surgical intervention, 4) colostomy creation, and 5) mortality. White race and private insurance were reference groups.
We identified 253,655 admissions. Race distribution included 77.7% white, 8.1% black, and 7.2% Hispanic. Medicare was the most commonly held insurance (52.7%), and 73.7% of patients were admitted through the emergency department. Of 36,190 surgeries, 20,650 (57.1%) included colostomies, and 3.0% of all patients died. Race other than white and Medicaid insurance were the strongest predictors of admission via the emergency department (OR 1.34, 95% CI 1.12-1.60; OR 1.60, 95% CI 1.44-1.78). Patients categorized as black, Hispanic, Asian, or other were less likely to have complicated disease, surgery, and colostomy creation (OR 0.81, 95% CI 0.76-0.85; OR 0.87, 95% CI 0.81-0.94; and OR 0.67, 95% CI 0.61-0.74). Insurance was associated with higher rates of mortality; having Medicaid or no insurance were the strongest predictors (OR 1.61, 95% CI 1.36-1.89; OR 1.34, 95% CI 1.06-1.69).
In acute diverticulitis, race and insurance were associated with differential admission patterns, and patients categorized as black, Hispanic, Asian, or other were less likely to receive surgical treatment or colostomy. Insurance status, but not race, was associated with mortality. Future research is needed to further explore these differences in admission, treatment, and mortality.
种族身份和医疗保险与许多疾病的医疗保健结果差异相关，但与憩室炎无关。我们研究了种族身份和保险与因急性憩室炎住院患者的入院、治疗和死亡率之间的关系。
从 1985 年至 2006 年的纽约州全州规划和合作系统数据库中提取了非选择性憩室炎入院成年患者的数据。种族类别为白种非西班牙裔、黑种非西班牙裔、西班牙裔、亚洲人、其他种族和未知种族。使用多变量逻辑回归模型调整了保险、年份、患者因素、社区因素和医院因素，以研究种族身份和保险与表现、治疗和死亡率之间的关系。考虑了五个结果：1）通过急诊室入院，2）疾病表现复杂，3）手术干预，4）结肠造口术，5）死亡率。白人种族和私人保险为参考组。
我们确定了 253655 例入院。种族分布包括 77.7%的白人、8.1%的黑人、7.2%的西班牙裔。医疗保险是最常见的保险（52.7%），73.7%的患者通过急诊室入院。在 36190 例手术中，20650 例（57.1%）包括结肠造口术，所有患者中有 3.0%死亡。除白人以外的种族和医疗补助保险是通过急诊室入院的最强预测因素（OR 1.34，95%CI 1.12-1.60；OR 1.60，95%CI 1.44-1.78）。被归类为黑人、西班牙裔、亚洲人或其他种族的患者不太可能出现疾病复杂、手术和结肠造口术（OR 0.81，95%CI 0.76-0.85；OR 0.87，95%CI 0.81-0.94；OR 0.67，95%CI 0.61-0.74）。保险与更高的死亡率相关；拥有医疗补助或没有保险是最强的预测因素（OR 1.61，95%CI 1.36-1.89；OR 1.34，95%CI 1.06-1.69）。
在急性憩室炎中，种族和保险与不同的入院模式相关，被归类为黑人、西班牙裔、亚洲人或其他种族的患者不太可能接受手术治疗或结肠造口术。保险状况，但不是种族，与死亡率相关。需要进一步研究以进一步探讨这些在入院、治疗和死亡率方面的差异。
