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Disparities in colonoscopy utilization for lower gastrointestinal bleeding in rural vs urban settings in the United
Nagapratap Ganta1, Mina Aknouk1, Dina Alnabwani1
1Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States.
Insights
Lower gastrointestinal bleeds (LGIB) patients in rural hospitals received colonoscopies less often than urban patients. However, colonoscopy reduced mortality for LGIB patients in both settings, despite increasing length of stay and costs.
Area of Science:
- Gastroenterology
- Health Services Research
- Health Equity
Background:
- Lower gastrointestinal bleeds (LGIB) are a common inpatient condition in the US, presenting with varied severity.
- Limited research exists on disparities in colonoscopy utilization for LGIB patients between urban and rural settings.
Purpose of the Study:
- To investigate differences in colonoscopy utilization for lower gastrointestinal bleeding between patients hospitalized in urban and rural hospitals.
- To analyze the impact of colonoscopy on in-hospital mortality, length of stay, and costs for LGIB patients.
Main Methods:
- Retrospective cohort study using National Inpatient Sample data (2010-2016).
- Included 157,748 patients aged 18+ hospitalized with LGIB.
- Used logistic regression and generalized linear models to analyze colonoscopy utilization, mortality, length of stay, and costs.
Main Results:
- Colonoscopy utilization was lower in rural (37.9%) versus urban (45.1%) hospitals (OR = 0.730).
- Colonoscopy was associated with reduced in-hospital mortality (OR = 0.498).
- Colonoscopy increased length of stay by 0.72 days and costs by approximately $2199.
Conclusions:
- Despite lower utilization in rural areas, colonoscopy for LGIB patients in both urban and rural hospitals decreased in-hospital mortality.
- The benefits of colonoscopy for LGIB patients were associated with extended hospital stays and increased costs.
Background:
Lower gastrointestinal bleeds (LGIB) is a very common inpatient condition in the United States. Gastrointestinal bleeds have a variety of presentations, from minor bleeding to severe hemorrhage and shock. Although previous studies investigated the efficacy of colonoscopy in hospitalized patients with LGIB, there is limited research that discusses disparities in colonoscopy utilization in patients with LGIB in urban and rural settings.
Aim:
To investigate the difference in utilization of colonoscopy in lower gastrointestinal bleeding between patients hospitalized in urban and rural hospitals.
Methods:
This is a retrospective cohort study of 157748 patients using National Inpatient Sample data and the Healthcare Cost and Utilization Project provided by the Agency for Healthcare Research and Quality. It includes patients 18 years and older hospitalized with LGIB admitted between 2010 and 2016. This study does not differentiate between acute and chronic LGIB and both are included in this study. The primary outcome measure of this study was the utilization of colonoscopy among patients in rural and urban hospitals admitted for lower gastrointestinal bleeds; the secondary outcome measures were in-hospital mortality, length of stay, and costs involved in those receiving colonoscopy for LGIB. Statistical analyses were all performed using STATA software. Logistic regression was used to analyze the utilization of colonoscopy and mortality, and a generalized linear model was used to analyze the length of stay and cost.
Results:
Our study found that 37.9% of LGIB patients at rural hospitals compared to approximately 45.1% at urban hospitals received colonoscopy, (OR = 0.730, 95%CI: 0.705-0.7, P > 0.0001). After controlling for covariates, colonoscopies were found to have a protective association with lower in-hospital mortality (OR = 0.498, 95%CI: 0.446-0.557, P < 0.0001), but a longer length of stay by 0.72 d (95%CI: 0.677-0.759 d, P < 0.0001) and approximately $2199 in increased costs.
Conclusion:
Although there was a lower percentage of LGIB patients that received colonoscopies in rural hospitals compared to urban hospitals, patients in both urban and rural hospitals with LGIB undergoing colonoscopy had decreased in-hospital mortality. In both settings, benefit came at a cost of extended stay, and higher total costs.
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