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Treatment Disparities and Trends in Diverticular Hemorrhage in the United States: A 2007 Population-based Study: 2010 ACG Lawlor Resident Award

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Raizada, Akshay MD, MPH1; Lee, Peter MD, MPH2; Dao, Haisar MD2; Hackford, Alan MD2; Coppolino, Michael MD1

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American Journal of Gastroenterology: October 2010 - Volume 105 - Issue - p S139-S140
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Purpose: Diverticular hemorrhage is considered the most common cause of lower gastrointestinal (GI) bleeding in the western world, accounting for approximately 50% of all cases. However, the epidemiology of diverticular hemorrhage and potential disparities in its treatment and clinical outcomes are not well described in the literature. The objective of this study is to characterize the patients being admitted for diverticular hemorrhage in the U.S. and to identify treatment and outcome disparities based on various social and demographic factors.

Methods: Data were obtained from the 2007 Nationwide Inpatient Sample (NIS), which includes 100% of all patient discharges from a 20% stratified sample of all U.S. hospitals. Procedures and diagnoses were identified using ICD-9 codes. We identified patients admitted for diverticular hemorrhage based on age, sex, race, insurance coverage, type of health facility (teaching vs. non-teaching), and determined outcomes, including length of stay, type of treatment, and mortality. A weighted file was utilized to estimate national estimates. Other causes of lower GI bleeding were excluded.

Results: A total of 98,028 patients were admitted in 2007 with a diagnosis of diverticular hemorrhage, with a mean age±SD of 75.7±12 years. The mean±SD length of stay was 5.15±7 days. 45% were males and 74% were white. 94% of the patients admitted were insured and 71% were admitted to teaching hospitals. Only 2.6% of patients underwent angiography while 3.9% underwent surgical resection. In-hospital mortality was 1.8%. Colonoscopies were more common in non-white patients compared to whites (p<0.0001, Odds ratio [OR] 1.26, 95% Confidence Interval [CI] 1.29-1.31) and in teaching hospitals compared to non-teaching hospitals (p<0.0001, OR 1.15, 95% CI 1.12-1.19). Insurance status did not influence the rate of colonoscopies (p=0.43). No association was found between race and mortality (p=0.68). White patients, however, were more likely to undergo surgery (p<0.0052, OR 1.13, 95% CI 1.03-1.24) and less likely to get angiography (p<0.0001, OR 0.7, 95% CI 0.70-0.85) compared to non-whites. Although teaching hospitals performed more angiographies (p<0.001, OR 2.965, 95% CI 2.7-3.2), there was no association between the teaching status of the hospital and the rate of surgeries (p=0.0574).

Conclusion: Diverticular hemorrhage is a common cause of admission in the U.S. However, racial disparities do appear to exist in the treatment patterns for this disease. Further research is warranted to determine the nature of these disparities.

© The American College of Gastroenterology 2010. All Rights Reserved.