Luther Janki P, Fritz Cassandra D L, Fanous Erika, Waken R J, Hammond J Gmerice, Joynt Maddox Karen E
Division of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri.
Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri.
Gastro Hep Adv. 2022 Jul 31;1(6):985-992. doi: 10.1016/j.gastha.2022.07.016. eCollection 2022.
The impact of sociodemographic factors on outcomes in patients with ulcerative colitis (UC) is not well studied. We characterized the association of race/ethnicity and insurance status with procedures, length of stay (LOS), mortality, and cost of care in a cohort of hospitalized patients with UC.
Data from the National Inpatient Sample from 2016 to 2018 were used. Outcomes were analyzed using generalized estimating equations. All models included age, sex, income quartile, hospital diagnosis, hospital characteristics, and Elixhauser Comorbidity Index as well as the primary predictors.
A total of 34,814 patients were included. Black (adjusted odds ratio [aOR] 0.46, 95% confidence interval [0.39-0.55]) or Hispanic (aOR 0.74, [0.64-0.86]) patients had lower odds of colectomy than White patients. Patients with Medicare (aOR 0.54, [0.48-0.62), Medicaid (aOR 0.51, [0.45-0.58]), or no insurance (aOR 0.42, [0.35-0.50]) had lower odds of colectomy than privately insured patients. Black patients had higher mortality than White patients (aOR 1.38, [1.07-1.78]). Patients with Medicare or Medicaid had 5% ([1.01-1.09]) and 9% longer LOS ([1.05-1.13]), respectively, than privately insured patients, while uninsured patients had a 6% shorter LOS ([0.90-0.97]). Hispanic or Asian/Native American patients had 11% ([1.06-1.15]) and 13% ([1.07-1.20]) higher costs, respectively, than White patients. Uninsured patients had 11% lower hospitalization costs than privately insured patients ([0.85-0.94]).
Hospitalized patients with UC differed significantly in rates of colectomy, mortality, LOS, and costs based on race/ethnicity and insurance status. Further research is needed to understand the cause of these differences and develop targeted solutions to reduce these inequities.
社会人口学因素对溃疡性结肠炎（UC）患者治疗结局的影响尚未得到充分研究。我们在一组住院的UC患者中，对种族/民族和保险状况与手术、住院时间（LOS）、死亡率及医疗费用之间的关联进行了特征分析。
使用了2016年至2018年全国住院患者样本的数据。采用广义估计方程分析结局。所有模型均纳入了年龄、性别、收入四分位数、医院诊断、医院特征、埃利克斯豪泽合并症指数以及主要预测因素。
共纳入34,814例患者。黑人（调整优势比[aOR] 0.46，95%置信区间[0.39 - 0.55]）或西班牙裔（aOR 0.74，[0.64 - 0.86]）患者接受结肠切除术的几率低于白人患者。参加医疗保险（aOR 0.54，[0.48 - 0.62]）、医疗补助（aOR 0.51，[0.45 - 0.58]）或无保险（aOR 0.42，[0.35 - 0.50]）的患者接受结肠切除术的几率低于私人保险患者。黑人患者的死亡率高于白人患者（aOR 1.38，[1.07 - 1.78]）。参加医疗保险或医疗补助的患者住院时间分别比私人保险患者长5%（[1.01 - 1.09]）和9%（[1.05 - 1.13]），而无保险患者的住院时间短6%（[0.90 - 0.97]）。西班牙裔或亚裔/美洲原住民患者的费用分别比白人患者高11%（[1.06 - 1.15]）和13%（[1.07 - 1.20]）。无保险患者的住院费用比私人保险患者低11%（[0.85 - 0.94]）。
基于种族/民族和保险状况，住院的UC患者在结肠切除术发生率、死亡率、住院时间和费用方面存在显著差异。需要进一步研究以了解这些差异的原因，并制定针对性解决方案以减少这些不平等现象。
