Department of General Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
University of Massachusetts Medical School, Worcester, MA, USA.
Pediatr Res. 2020 Dec;88(6):887-893. doi: 10.1038/s41390-020-0830-9. Epub 2020 Mar 13.
To examine differences in comorbidities and surgical management based on socioeconomics in hospitalized children with Crohn's disease (CD).
Using the Kids' Inpatient Database for 2006-2012, we identified patients (<21 years) with a CD diagnosis. Cases were analyzed and stratified by median parental income by zip code. Multivariable logistic regression was performed.
Of the 28,337 pediatric CD hospitalizations identified, patients were more likely male (51.1%), non-Hispanic white (71.3%), and had a mean age of 15.9 years. The proportion of minority patients increased as income quartile declined. Higher income quartile patients were more likely to be coded with anxiety and less likely with anemia. The highest income quartile was more likely to have a bowel obstruction, and peritoneal/intestinal abscess and was also 28% more likely to undergo a major surgical procedure.
Significant variability exists in the reported comorbidities and surgical interventions associated with CD by income quartile. Lower income quartile patients are more likely to be of minority ethnicity and anemic, but less likely to undergo a major surgical procedure. Further investigation is warranted to determine whether these differences represent disease variability, differences in healthcare resource allocation, or implicit bias in management.
There is a disparity in the care of children and young adults with Crohn's disease based on parental income. Links between parental income and the treatment of Crohn's disease in children and young adults has not been assessed in national datasets in the United States. Children in the highest income quartile were more likely to undergo a major surgical procedure. The variations in healthcare for hospitalized children and young adults with CD found in this study may represent variability in patient disease, implicit bias, or a disparity in healthcare delivery across the United States.
本研究旨在探讨基于社会经济学的住院儿童克罗恩病（CD）合并症和手术管理的差异。
我们使用 2006 年至 2012 年的儿童住院数据库，确定患有 CD 诊断的患者（<21 岁）。通过邮政编码中位数父母收入对病例进行分析和分层。采用多变量逻辑回归。
在确定的 28337 例儿科 CD 住院患者中，患者更可能为男性（51.1%）、非西班牙裔白人（71.3%），平均年龄为 15.9 岁。少数民族患者的比例随着收入四分位下降而增加。较高收入四分位数的患者更可能被编码为焦虑，较少可能被编码为贫血。最高收入四分位数更可能发生肠梗阻、腹腔/肠脓肿，并且更有可能接受主要手术。
按收入四分位数报告的 CD 相关合并症和手术干预存在显著差异。较低收入四分位数的患者更可能为少数民族且贫血，但不太可能接受主要手术。需要进一步调查，以确定这些差异是否代表疾病变异性、医疗保健资源分配差异或管理中的隐性偏见。
根据父母收入，儿童和青少年克罗恩病的护理存在差异。在美国国家数据库中，尚未评估父母收入与儿童和青少年克罗恩病治疗之间的联系。收入最高四分位数的儿童更有可能接受主要手术。本研究中发现的住院儿童和青少年 CD 患者的医疗保健差异可能代表患者疾病的变异性、隐性偏见或美国医疗保健提供的差异。
