Treatment Utilization and Socioeconomic Disparities in the Surgical Management of Gastroparesis

Katherine D Gray, Timothy M Ullmann, Adham Elmously, Toni Beninato, Thomas J Fahey, Alfons Pomp, Rasa Zarnegar, Cheguevara Afaneh
Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract 2019 July 10

BACKGROUND: Gastroparesis is an end-organ sequela of diabetes. We evaluated the roles of race and socioeconomic status in hospitalization rates and utilization of surgical treatments in these patients.

METHODS: Data was extracted from the National Inpatient Sample (NIS) between the years 2012 and 2014, and any discharge diagnosis of gastroparesis (536.3) was included. Gastrostomy, jejunostomy, and total parenteral nutrition were considered nutritional support procedures, and procedures aimed at improving motility were considered definitive disease-specific procedures: pyloroplasty, endoscopic pyloric dilation, gastric pacemaker placement, and gastrectomy.

RESULTS: There were 747,500 hospitalizations reporting a discharge diagnosis of gastroparesis. On multivariable analysis, black race (OR 1.93, 95% CI 1.89-1.98; p < 0.001) and Medicaid insurance (OR 1.46, 95% CI 1.42-1.50; p < 0.001) were the strongest socioeconomic risk factors for hospitalization due to gastroparesis. Patients in urban teaching institutions were most likely to undergo a surgical intervention for gastroparesis (5.53% of patients versus 3.94% of patients treated in urban non-teaching hospitals and 2.38% of patients in rural hospitals; p < 0.001). Uninsured patients were less than half as likely to receive treatment compared to those with private insurance (OR 0.41, 95% CI 0.34-0.48; p < 0.001), and black patients had an OR 0.75 (95% CI 0.69-0.81; p < 0.001) for receiving treatment. Urban teaching hospitals had a twofold higher likelihood of intervention (OR 2.12, 95% CI 1.84-2.44; p < 0.001).

CONCLUSIONS: Marked racial and economic disparities exist in surgical distribution of care for gastroparesis, potentially driven by differences in utilization of care.


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