Vanderbilt University School of Medicine, Nashville, TN.
Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
Surgery. 2021 Dec;170(6):1637-1643. doi: 10.1016/j.surg.2021.05.049. Epub 2021 Jun 26.
Racial discrepancies in treatment and outcomes of acute diverticulitis have been observed, yet underlying factors are poorly understood. We aimed to identify racial inequalities in health literacy among patients hospitalized with acute diverticulitis and characterize factors associated with more severe presentation.
We performed a retrospective cohort analysis of 947 Black or White patients admitted with acute diverticulitis at a quaternary referral center from January 2009 through September 2019. Health literacy was determined by the validated Brief Health Literacy Screening, and socioeconomic status was defined by the area deprivation index, a composite of multiple neighborhood socioeconomic deprivation measures. The primary outcome was severity of disease presentation represented by systemic inflammatory response syndrome criteria; secondary outcomes included intensive care unit admission, length of stay, and invasive interventions.
Among all study participants, 121 (12.8%) self-identified as Black. Overall, 140 (14.8%) patients had inadequate health literacy, and 495 (52.3%) had area deprivation index greater than the national median. There was no association between race or area deprivation index and health literacy. A total of 340 (35.9%) patients met criteria for systemic inflammatory response syndrome, and 88 (9.3%) underwent an intervention; median length of stay was 3.5 days. Race, health literacy, and area deprivation index were not significantly associated with outcomes (P > .05).
Among patients with acute diverticulitis, no difference in severity of presentation by race, health literacy, or area deprivation index was observed. These findings suggest that differences in presentation of acute diverticulitis may not be driven by these social factors. Future studies should include considerations of clinical characteristics of acute diverticulitis, such as the role of access and underuse of healthcare resources.
在急性憩室炎的治疗和结果方面存在种族差异，但潜在因素仍不清楚。我们旨在确定因急性憩室炎住院的患者健康素养方面的种族不平等，并描述与更严重表现相关的因素。
我们对 2009 年 1 月至 2019 年 9 月在一家四级转诊中心因急性憩室炎入院的 947 名黑人和白人患者进行了回顾性队列分析。健康素养通过经过验证的简短健康素养筛查确定，社会经济地位由区域剥夺指数定义，这是多种邻里社会经济剥夺措施的综合指标。主要结局是代表全身炎症反应综合征标准的疾病表现严重程度；次要结局包括重症监护病房入院、住院时间和侵入性干预。
在所有研究参与者中，有 121 名（12.8%）自认为是黑人。总体而言，有 140 名（14.8%）患者健康素养不足，有 495 名（52.3%）患者区域剥夺指数高于全国中位数。种族或区域剥夺指数与健康素养之间没有关联。共有 340 名（35.9%）患者符合全身炎症反应综合征标准，有 88 名（9.3%）接受了干预；中位住院时间为 3.5 天。种族、健康素养和区域剥夺指数与结局无显著相关性（P＞.05）。
在急性憩室炎患者中，未观察到种族、健康素养或区域剥夺指数与表现严重程度有关。这些发现表明，急性憩室炎的表现差异可能不是由这些社会因素驱动的。未来的研究应考虑急性憩室炎的临床特征，例如医疗保健资源的利用不足。
