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Socioeconomic disparities in ostomy reversal among older adults with diverticulitis are more substantial among non-Hispanic Black patients.
Reid, Trista D; Shrestha, Riju; Stone, Lucas; Gallaher, Jared; Charles, Anthony G; Strassle, Paula D.
Afiliação
  • Reid TD; The University of North Carolina-Chapel Hill, Department of Surgery, Chapel Hill, NC. Electronic address: trista_reid@med.unc.edu.
  • Shrestha R; The University of North Carolina-Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC.
  • Stone L; The University of North Carolina-Chapel Hill, Department of Surgery, Chapel Hill, NC.
  • Gallaher J; The University of North Carolina-Chapel Hill, Department of Surgery, Chapel Hill, NC.
  • Charles AG; The University of North Carolina-Chapel Hill, Department of Surgery, Chapel Hill, NC.
  • Strassle PD; Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health.
Surgery ; 170(4): 1039-1046, 2021 10.
Article em En | MEDLINE | ID: mdl-33933283
BACKGROUND: While ostomies for diverticulitis are often intended to be temporary, ostomy reversal rates can be as low as 46%. There are few comprehensive studies evaluating the effects of socioeconomic status as a disparity in ostomy reversal. We hypothesized that among the elderly Medicare population undergoing partial colectomy for diverticulitis, lower socioeconomic status would be associated with reduced reversal rates. METHODS: Retrospective cohort study using a 20% representative sample of Medicare beneficiaries >65 years old with diverticulitis who received ostomies between January 1, 2010, to December 31, 2017. We evaluated the effect of neighborhood socioeconomic status, measured by the Social Deprivation Index, on ostomy reversal within 1 year. Secondary outcomes were complications and mortality. RESULTS: Of 10,572 patients, ostomy reversals ranged from 21.2% (low socioeconomic status) to 29.8% (highest socioeconomic status), with a shorter time to reversal among higher socioeconomic status groups. Patients with low socioeconomic status were less likely to have their ostomies reversed, compared with the highest socioeconomic status group (hazard ratio 0.83, 95% confidence interval 0.74-0.93) and were more likely to die (hazard ratio 1.21, 95% confidence interval 1.10-1.33). When stratified by race/ethnicity and socioeconomic status, non-Hispanic White patients at every socioeconomic status had a higher reversal rate than non-Hispanic Black patients (White patients 32.0%-24.8% vs Black patients 19.6%-14.7%). Socioeconomic status appeared to have a higher relative impact among non-Hispanic Black patients. CONCLUSION: Among Medicare diverticulitis patients, ostomy reversal rates are low. Patients with lower socioeconomic status are less likely to undergo stoma reversal and are more likely to die; Black patients are least likely to have an ostomy reversal.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Negro ou Afro-Americano / Estomia / Medicare / Colectomia / Doença Diverticular do Colo / Disparidades em Assistência à Saúde Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Negro ou Afro-Americano / Estomia / Medicare / Colectomia / Doença Diverticular do Colo / Disparidades em Assistência à Saúde Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Ano de publicação: 2021 Tipo de documento: Article