TY - JOUR
T1 - Ethnicity and insurance status affect health disparities in patients with gallstone disease
AU - Freeman, Jennifer
AU - Boomer, Laura
AU - Fursevich, Dzmitry
AU - Feliz, Alexander
PY - 2012/6/1
Y1 - 2012/6/1
N2 - Background: Complex gallstone disease is associated with greater risk of morbidity, associated with operative complications and longer hospital stays. The purpose of this study is to evaluate whether ethnicity or insurance status is associated with differences in presentation and outcomes in gallstone disease. Materials and Methods: A retrospective analysis was performed for all patients who underwent cholecystectomy between August 1, 2007 and May 31, 2010 at the only teaching hospital in the region. Analysis of Variance, Chi square (χ 2) and logistical regression analyses were used to evaluate the impact of ethnicity and insurance status on the complexity of gallstone disease and surgical outcomes. Results: A total of 562 patients had a cholecystectomy during the study period, of whom 255 (45.4%) were Latino. Latino patients were significantly younger than any other ethnic group (P < 0.001) and had a significantly higher rate of being uninsured (40%, P = 0.03). Latino patients were significantly more likely to require ERCP (38.6% versus 28.8% for non-Latino, P = 0.01). Latino patients had a significantly higher white blood cell count (P = 0.017). There were no significant differences in liver function tests, bilirubin levels, albumin levels, hospital lengths of stay, operation types, pathology types, or complication rates between ethnic groups. Uninsured patients were significantly younger (P = 0.003) and were more likely to require an ERCP (39.5% versus 26.8% for privately insured and 31.9% for publicly insured, P = 0.04). Patients with no insurance were significantly more likely to have a higher white blood cell count (P = 0.039) and aspartate aminotransferase (AST) level (P = 0.04). Patients with public insurance and no insurance had a significantly longer median length of hospital stay (4.0 d versus 3.0 d for privately insured, P = 0.045). There were no significant differences in operation types, complication rates, or pathologic diagnosis based on insurance status. Conclusions: In our population, ethnicity and insurance status do play a role in the presentation and care of patients with gallstone disease. Latino and uninsured patients present with a higher complexity of disease and require interventions more frequently.
AB - Background: Complex gallstone disease is associated with greater risk of morbidity, associated with operative complications and longer hospital stays. The purpose of this study is to evaluate whether ethnicity or insurance status is associated with differences in presentation and outcomes in gallstone disease. Materials and Methods: A retrospective analysis was performed for all patients who underwent cholecystectomy between August 1, 2007 and May 31, 2010 at the only teaching hospital in the region. Analysis of Variance, Chi square (χ 2) and logistical regression analyses were used to evaluate the impact of ethnicity and insurance status on the complexity of gallstone disease and surgical outcomes. Results: A total of 562 patients had a cholecystectomy during the study period, of whom 255 (45.4%) were Latino. Latino patients were significantly younger than any other ethnic group (P < 0.001) and had a significantly higher rate of being uninsured (40%, P = 0.03). Latino patients were significantly more likely to require ERCP (38.6% versus 28.8% for non-Latino, P = 0.01). Latino patients had a significantly higher white blood cell count (P = 0.017). There were no significant differences in liver function tests, bilirubin levels, albumin levels, hospital lengths of stay, operation types, pathology types, or complication rates between ethnic groups. Uninsured patients were significantly younger (P = 0.003) and were more likely to require an ERCP (39.5% versus 26.8% for privately insured and 31.9% for publicly insured, P = 0.04). Patients with no insurance were significantly more likely to have a higher white blood cell count (P = 0.039) and aspartate aminotransferase (AST) level (P = 0.04). Patients with public insurance and no insurance had a significantly longer median length of hospital stay (4.0 d versus 3.0 d for privately insured, P = 0.045). There were no significant differences in operation types, complication rates, or pathologic diagnosis based on insurance status. Conclusions: In our population, ethnicity and insurance status do play a role in the presentation and care of patients with gallstone disease. Latino and uninsured patients present with a higher complexity of disease and require interventions more frequently.
KW - ethnicity
KW - gallstone disease
KW - health care disparities
KW - insurance
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U2 - 10.1016/j.jss.2011.06.064
DO - 10.1016/j.jss.2011.06.064
M3 - Article
C2 - 21872888
AN - SCOPUS:84860329617
SN - 0022-4804
VL - 175
SP - 1
EP - 5
JO - Journal of Surgical Research
JF - Journal of Surgical Research
IS - 1
ER -