Racial Disparities in Management of Diverticulitis: Examining Elective and Nonelective Admissions

Author(s):
Andrew Tran; Maria Barahona; Caleb W. Curry; Allison Gasnick; Justin Brady; Justin Dvorak; Esther Tseng; Vanessa Ho

Background:

Prior studies on patients with surgically managed diverticulitis have shown that Americans from minority race and ethnicity groups have higher mortality risk after adjusting for other factors. Differential application of operative management could help explain this disparity.

Hypothesis:

There are racial and ethnic differences in the application of operative management in patients electively and urgently admitted for diverticulitis.

Methods:

We utilized the 2016-2017 National Inpatient Sample and included all adults aged 18 and older with an admission diagnosis consistent with diverticulitis. Admissions were categorized as elective or urgent. The outcome of interest was an operation for diverticulitis, which included colectomy, colostomy, or anastomosis with ileostomy. Race was categorized as white, Black, Hispanic, or other. We also collected gender, age, Elixhauser comorbidities, and hospital variables as covariates. Adjusted logistic regressions were performed for the urgent and elective cohorts, to assess differences whether race and ethnicity was associated with the use of operative management.

Results:

Among 344,256 individuals with diverticulitis (56% female, median age 70 [IQR 59-80]), of whom 48,502 (14%) were admitted electively. Operative management was utilized much more frequently in elective admissions (19%) than in urgent admissions (4%), p<0.001). The proportion of patients who were Black was significantly lower in elective admissions (7%) than in urgent admissions (12%), p<0.001. In both elective and urgent admissions, Black, Hispanic, and other minority patients were less likely to receive operative management after adjustment for other factors (Table).

Conclusions:

In diverticulitis, elective surgery can mitigate the risk of urgent surgeries with high complication rates. Our data suggests that Black patients are not admitted electively as frequently as their counterparts, and represent a smaller proportion of both elective and urgent surgeries. These data suggest a racial and ethnic bias in patient selection for elective treatment of diverticulitis.