While race may be associated with the level of presentation and mortality for diverticulitis, but insurance status is associated with other aspects of treatment, according to an article released on December 15, 2008 in Archives of Surgery, one of the JAMA/Archives journals.
Diverticulitis is the inflammation and infection of the colon within small extensions called diverticula; the colon wall may break or perforate as a result. According to the background information in the article, this accounts for at least 200,000 hospitalizations and over $300 million USD in health care costs each year.
Complicated diverticulitis is accompanied by bowel obstruction, hemorrhage, perforation, or abscess formation, and leaves the patient and doctor with several treatment options to consider. “Complicated diverticulitis is managed by hospital admission, bowel rest, intravenous antibiotics, and, depending on the patient’s condition, either emergency surgery or conservative management,” write the authors. Surgical interventions usually entail removal of the diseased portion of the colon, allowing the healthy sections to be reattached. This process can be done all at once, or in two stages with intermediate use of a colostomy to remove waste through the abdomen. This latter option can be difficult for patients for many reasons: “The need for a colostomy usually relates to higher disease severity at presentation and is difficult for patients from a functional as well as emotional standpoint.”
To investigate the association between race, ethnicity, or insurance status on treatment for diverticulitis, Anne O. Lidor, M.D., M.P.H., and colleagues at Johns Hopkins University, Baltimore, retrospectively analyzed records of 45,528 patients diagnosed with diverticulitis and admitted into hospitals in the United States between 1999 and 2003. In the population, 85.3% of participants were white, 5.3% were black, and 6.7% were underinsured.
The authors found that race did not have a significant correlation with the treatment. “In our study, we found that race did not affect the type of surgical treatment received for diverticulitis, notwithstanding that black patients were more likely than white patients to present with more complicated cases,” they write. “In contrast, insurance status did correlate with the type of treatment provided. Uninsured and underinsured patients were more likely to receive a colostomy, even after adjusting for a higher rate of complicated diverticulitis in those patients than their insured counterparts.”
The authors conclude that a stronger predictor of treatment patterns for diverticulitis may be inadequate health insurance. “This, to some degree, questions the conventional wisdom that race is the primary determinant of suboptimal outcomes in health care delivery and has obvious prescriptive implications for future health care policy decisions,” they write. “To the extent to which these findings can be generalized to a variety of other medical conditions, a new paradigm of health care resource allocation may be in order, one based more on socioeconomic than racial distinctions. Future research should assess the means by which barriers to equal access to adequate health care can be reduced or eliminated by negating socioeconomic factors rather than emphasizing race-based distinctions.”
Effect of Race and Insurance Status on Presentation, Treatment, and Mortality in Patients Undergoing Surgery for Diverticulitis
Anne O. Lidor, MD, MPH; Susan L. Gearhart, MD; Albert W. Wu, MD, MPH; David C. Chang, PhD, MPH, MBA
Arch Surg. 2008;143(12):1160-1165.
Written by Anna Sophia McKenney