Race and health insurance are predictors of hospitalized Crohn's disease patients undergoing bowel resection

Geoffrey C. Nguyen, Theodore M Bayless, Neil R. Powe, Thomas A. Laveist, Steven R. Brant

Research output: Contribution to journalArticle

Abstract

Background: Racial disparities in utilization of major surgical procedures have been well documented in the United States over the last decade. Crohn's disease (CD) is a chronically relapsing disorder that leads to significant morbidity and, in most cases, surgery. Our objective was to characterize health disparities in CD-related bowel resection among hospitalized CD patients. Methods: We analyzed discharge records from the Nationwide Inpatient Sample, the largest nationally representative database of acute-care hospitals throughout the United States. A total of 41,918 discharges with CD from 1998 to 2003 were included. Bowel resection and in-hospital mortality rates for non-Hispanic whites, African Americans, Hispanics, and non-Hispanic Asians were calculated. Results: After adjusting for age, sex, health insurance, comorbidity, median neighborhood income, and hospital characteristics, the relative rate ratio of undergoing bowel resection for African Americans, Hispanics, and Asians compared to whites was 0.68 (95% confidence interval [CI]: 0.61-0.76), 0.70 (95% CI: 0.60-0.83), and 0.31 (95% CI: 0.16-0.59), respectively. Compared to those with private insurance, the relative risk of surgery for those with Medicare, those with Medicaid, and those who were "self-pay" was 0.48 (95% CI: 0.44-0.54), 0.52 (95% CI: 0.46-0.59), and 0.67 (95% CI: 0.58-0.77), respectively. Women were less likely than men to undergo bowel resection (incidence rate ratio [IRR] = 0.80; 95% CI: 0.76-0.85). The in-hospital mortality of individuals who resided in neighborhoods whose median income was above the national median was lower (IRR = 0.71; 95% CI: 0.50-0.99). Conclusions: Bowel resection among hospitalized CD patients varies by race, health insurance, and sex. Further mechanistic studies are needed to elucidate the social and biological underpinnings of these variations.

Original languageEnglish (US)
Pages (from-to)1408-1416
Number of pages9
JournalInflammatory Bowel Diseases
Volume13
Issue number11
DOIs
StatePublished - Nov 2007

Fingerprint

Health Insurance
Crohn Disease
Confidence Intervals
Hospital Mortality
Hispanic Americans
African Americans
Incidence
Medicaid
Medicare
Insurance
Comorbidity
Inpatients
Databases
Morbidity
Mortality
Health

Keywords

  • Crohn's disease
  • Health insurance
  • Hospitalization
  • Inflammatory bowel disease
  • Minority studies
  • Surgery for IBD

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Race and health insurance are predictors of hospitalized Crohn's disease patients undergoing bowel resection. / Nguyen, Geoffrey C.; Bayless, Theodore M; Powe, Neil R.; Laveist, Thomas A.; Brant, Steven R.

In: Inflammatory Bowel Diseases, Vol. 13, No. 11, 11.2007, p. 1408-1416.

Research output: Contribution to journalArticle

Nguyen, Geoffrey C. ; Bayless, Theodore M ; Powe, Neil R. ; Laveist, Thomas A. ; Brant, Steven R. / Race and health insurance are predictors of hospitalized Crohn's disease patients undergoing bowel resection. In: Inflammatory Bowel Diseases. 2007 ; Vol. 13, No. 11. pp. 1408-1416.
@article{db201d2ad4a8415589f3c3e3583bb535,
title = "Race and health insurance are predictors of hospitalized Crohn's disease patients undergoing bowel resection",
abstract = "Background: Racial disparities in utilization of major surgical procedures have been well documented in the United States over the last decade. Crohn's disease (CD) is a chronically relapsing disorder that leads to significant morbidity and, in most cases, surgery. Our objective was to characterize health disparities in CD-related bowel resection among hospitalized CD patients. Methods: We analyzed discharge records from the Nationwide Inpatient Sample, the largest nationally representative database of acute-care hospitals throughout the United States. A total of 41,918 discharges with CD from 1998 to 2003 were included. Bowel resection and in-hospital mortality rates for non-Hispanic whites, African Americans, Hispanics, and non-Hispanic Asians were calculated. Results: After adjusting for age, sex, health insurance, comorbidity, median neighborhood income, and hospital characteristics, the relative rate ratio of undergoing bowel resection for African Americans, Hispanics, and Asians compared to whites was 0.68 (95{\%} confidence interval [CI]: 0.61-0.76), 0.70 (95{\%} CI: 0.60-0.83), and 0.31 (95{\%} CI: 0.16-0.59), respectively. Compared to those with private insurance, the relative risk of surgery for those with Medicare, those with Medicaid, and those who were {"}self-pay{"} was 0.48 (95{\%} CI: 0.44-0.54), 0.52 (95{\%} CI: 0.46-0.59), and 0.67 (95{\%} CI: 0.58-0.77), respectively. Women were less likely than men to undergo bowel resection (incidence rate ratio [IRR] = 0.80; 95{\%} CI: 0.76-0.85). The in-hospital mortality of individuals who resided in neighborhoods whose median income was above the national median was lower (IRR = 0.71; 95{\%} CI: 0.50-0.99). Conclusions: Bowel resection among hospitalized CD patients varies by race, health insurance, and sex. Further mechanistic studies are needed to elucidate the social and biological underpinnings of these variations.",
keywords = "Crohn's disease, Health insurance, Hospitalization, Inflammatory bowel disease, Minority studies, Surgery for IBD",
author = "Nguyen, {Geoffrey C.} and Bayless, {Theodore M} and Powe, {Neil R.} and Laveist, {Thomas A.} and Brant, {Steven R.}",
year = "2007",
month = "11",
doi = "10.1002/ibd.20200",
language = "English (US)",
volume = "13",
pages = "1408--1416",
journal = "Inflammatory Bowel Diseases",
issn = "1078-0998",
publisher = "John Wiley and Sons Inc.",
number = "11",

}

TY - JOUR

T1 - Race and health insurance are predictors of hospitalized Crohn's disease patients undergoing bowel resection

AU - Nguyen, Geoffrey C.

AU - Bayless, Theodore M

AU - Powe, Neil R.

AU - Laveist, Thomas A.

AU - Brant, Steven R.

PY - 2007/11

Y1 - 2007/11

N2 - Background: Racial disparities in utilization of major surgical procedures have been well documented in the United States over the last decade. Crohn's disease (CD) is a chronically relapsing disorder that leads to significant morbidity and, in most cases, surgery. Our objective was to characterize health disparities in CD-related bowel resection among hospitalized CD patients. Methods: We analyzed discharge records from the Nationwide Inpatient Sample, the largest nationally representative database of acute-care hospitals throughout the United States. A total of 41,918 discharges with CD from 1998 to 2003 were included. Bowel resection and in-hospital mortality rates for non-Hispanic whites, African Americans, Hispanics, and non-Hispanic Asians were calculated. Results: After adjusting for age, sex, health insurance, comorbidity, median neighborhood income, and hospital characteristics, the relative rate ratio of undergoing bowel resection for African Americans, Hispanics, and Asians compared to whites was 0.68 (95% confidence interval [CI]: 0.61-0.76), 0.70 (95% CI: 0.60-0.83), and 0.31 (95% CI: 0.16-0.59), respectively. Compared to those with private insurance, the relative risk of surgery for those with Medicare, those with Medicaid, and those who were "self-pay" was 0.48 (95% CI: 0.44-0.54), 0.52 (95% CI: 0.46-0.59), and 0.67 (95% CI: 0.58-0.77), respectively. Women were less likely than men to undergo bowel resection (incidence rate ratio [IRR] = 0.80; 95% CI: 0.76-0.85). The in-hospital mortality of individuals who resided in neighborhoods whose median income was above the national median was lower (IRR = 0.71; 95% CI: 0.50-0.99). Conclusions: Bowel resection among hospitalized CD patients varies by race, health insurance, and sex. Further mechanistic studies are needed to elucidate the social and biological underpinnings of these variations.

AB - Background: Racial disparities in utilization of major surgical procedures have been well documented in the United States over the last decade. Crohn's disease (CD) is a chronically relapsing disorder that leads to significant morbidity and, in most cases, surgery. Our objective was to characterize health disparities in CD-related bowel resection among hospitalized CD patients. Methods: We analyzed discharge records from the Nationwide Inpatient Sample, the largest nationally representative database of acute-care hospitals throughout the United States. A total of 41,918 discharges with CD from 1998 to 2003 were included. Bowel resection and in-hospital mortality rates for non-Hispanic whites, African Americans, Hispanics, and non-Hispanic Asians were calculated. Results: After adjusting for age, sex, health insurance, comorbidity, median neighborhood income, and hospital characteristics, the relative rate ratio of undergoing bowel resection for African Americans, Hispanics, and Asians compared to whites was 0.68 (95% confidence interval [CI]: 0.61-0.76), 0.70 (95% CI: 0.60-0.83), and 0.31 (95% CI: 0.16-0.59), respectively. Compared to those with private insurance, the relative risk of surgery for those with Medicare, those with Medicaid, and those who were "self-pay" was 0.48 (95% CI: 0.44-0.54), 0.52 (95% CI: 0.46-0.59), and 0.67 (95% CI: 0.58-0.77), respectively. Women were less likely than men to undergo bowel resection (incidence rate ratio [IRR] = 0.80; 95% CI: 0.76-0.85). The in-hospital mortality of individuals who resided in neighborhoods whose median income was above the national median was lower (IRR = 0.71; 95% CI: 0.50-0.99). Conclusions: Bowel resection among hospitalized CD patients varies by race, health insurance, and sex. Further mechanistic studies are needed to elucidate the social and biological underpinnings of these variations.

KW - Crohn's disease

KW - Health insurance

KW - Hospitalization

KW - Inflammatory bowel disease

KW - Minority studies

KW - Surgery for IBD

UR - http://www.scopus.com/inward/record.url?scp=36749088149&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=36749088149&partnerID=8YFLogxK

U2 - 10.1002/ibd.20200

DO - 10.1002/ibd.20200

M3 - Article

C2 - 17567876

AN - SCOPUS:36749088149

VL - 13

SP - 1408

EP - 1416

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

SN - 1078-0998

IS - 11

ER -