Department of Surgery, New York Presbyterian Hospital - Weill Cornell Medicine, 525 East 68th St, Box 294, New York, NY, 10065, USA.
J Gastrointest Surg. 2020 Aug;24(8):1795-1801. doi: 10.1007/s11605-019-04294-x. Epub 2019 Jul 10.
Gastroparesis is an end-organ sequela of diabetes. We evaluated the roles of race and socioeconomic status in hospitalization rates and utilization of surgical treatments in these patients.
Data was extracted from the National Inpatient Sample (NIS) between the years 2012 and 2014, and any discharge diagnosis of gastroparesis (536.3) was included. Gastrostomy, jejunostomy, and total parenteral nutrition were considered nutritional support procedures, and procedures aimed at improving motility were considered definitive disease-specific procedures: pyloroplasty, endoscopic pyloric dilation, gastric pacemaker placement, and gastrectomy.
There were 747,500 hospitalizations reporting a discharge diagnosis of gastroparesis. On multivariable analysis, black race (OR 1.93, 95% CI 1.89-1.98; p < 0.001) and Medicaid insurance (OR 1.46, 95% CI 1.42-1.50; p < 0.001) were the strongest socioeconomic risk factors for hospitalization due to gastroparesis. Patients in urban teaching institutions were most likely to undergo a surgical intervention for gastroparesis (5.53% of patients versus 3.94% of patients treated in urban non-teaching hospitals and 2.38% of patients in rural hospitals; p < 0.001). Uninsured patients were less than half as likely to receive treatment compared to those with private insurance (OR 0.41, 95% CI 0.34-0.48; p < 0.001), and black patients had an OR 0.75 (95% CI 0.69-0.81; p < 0.001) for receiving treatment. Urban teaching hospitals had a twofold higher likelihood of intervention (OR 2.12, 95% CI 1.84-2.44; p < 0.001).
Marked racial and economic disparities exist in surgical distribution of care for gastroparesis, potentially driven by differences in utilization of care.
胃轻瘫是糖尿病的终末器官后遗症。我们评估了种族和社会经济地位在这些患者住院率和手术治疗利用中的作用。
从 2012 年至 2014 年期间从国家住院患者样本（NIS）中提取数据，并纳入任何胃轻瘫（536.3）的出院诊断。胃造口术、空肠造口术和全胃肠外营养被认为是营养支持程序，而旨在改善动力的程序被认为是针对特定疾病的明确程序：幽门成形术、内镜幽门扩张术、胃起搏器放置术和胃切除术。
有 747500 例住院治疗报告出院诊断为胃轻瘫。多变量分析显示，黑种人（比值比 1.93，95%置信区间 1.89-1.98；p<0.001）和医疗补助保险（比值比 1.46，95%置信区间 1.42-1.50；p<0.001）是因胃轻瘫住院的最强社会经济危险因素。在城市教学机构中，接受胃轻瘫手术干预的可能性最高（5.53%的患者与城市非教学医院接受治疗的 3.94%的患者和农村医院的 2.38%的患者相比；p<0.001）。与有私人保险的患者相比，没有保险的患者接受治疗的可能性不到一半（比值比 0.41，95%置信区间 0.34-0.48；p<0.001），黑种患者接受治疗的比值比为 0.75（95%置信区间 0.69-0.81；p<0.001）。城市教学医院干预的可能性增加了一倍（比值比 2.12，95%置信区间 1.84-2.44；p<0.001）。
胃轻瘫的手术治疗分配存在明显的种族和经济差异，这可能是由于护理利用的差异所致。
