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Mo1063 Impact of Race, Income and Health Insurance on Healthcare Outcomes of Hospital Acquired Conditions (HACs) in Inflammatory Bowel Disease (IBD) Patients: A Nationwide Population-Based Study
Mo1063
patients with Medicare were compared with patients with private insurance. The aOR of income was obtained when patients with high income were compared with patients with low income.
AGA Abstracts
Impact of Race, Income and Health Insurance on Healthcare Outcomes of Hospital Acquired Conditions (HACs) in Inflammatory Bowel Disease (IBD) Patients: A Nationwide Population-Based Study Kenneth Obi, Razvan Arsenescu, Alice Hinton, Cheng Zhang
Mo1064
Background: Crohn's disease (CD) and ulcerative colitis (UC) are chronically relapsing conditions that frequently require hospitalization. In 2008, the Centers for Medicare and Medicaid Services (CMS) identified 10 categories of preventable conditions that were considered to be HACs, for which reimbursement would not be provided. Objective: To determine the impact of race, income and health insurance on healthcare outcomes of hospitalized IBD patients who experienced HACs in the United States. Methods: This was a cross-sectional study using data from the Nationwide Inpatient Sample (NIS, 2012). IBD hospitalizations and HACs were identified using appropriate ICD-9-CM codes. We excluded patients under the age of 19 and those who carried the diagnoses of both UC and CD. We excluded HACs that were related to surgical procedures. The presence of HAC was defined as having at least one qualifying complications as listed by the CMS. The grades of income were determined based on the ZIP codes of patient's residence. Primary outcomes were in-hospital mortality, length of stay (LOS) and hospital charge. Secondary outcomes were frequency of blood transfusions and parenteral nutrition. All analyses were conducted with SAS, version 9.3, Cary, NC. Results: In 2012, there were a total of 63,845 CD discharges; of those, 290 experienced at least 1 HAC. In CD patients, HACs were associated with increased LOS, hospital charge, mortality, and blood product transfusion. In the UC population, there were 32,720 discharges with 255 patients experiencing HACs. HACs were associated with increased blood product transfusion in UC patients (Table 1). When compared with white patients, black CD patients with HACs had prolonged LOS, increased hospital charge, and increased transfusion needs. In UC patients with HACs, black patients had more blood transfusions. Hispanic patients had more hospital charge than white patients in both CD and UC groups. When compared with patients with private insurance, Medicare CD patients with HACs had prolonged LOS and Medicare UC patients with HACs were more likely to receive blood products. In CD patients with HACs, patients with high income had more hospital charges (Table 2). Conclusion: In patients with CD, HACs were associated with increased mortality and healthcare resource utilization (LOS, hospital charge, and blood transfusion). In patients with UC, HACs were only associated with increased frequency of blood transfusion. Healthcare utilization of CD patients with HACs was significantly impacted by race, insurance, and income. In contrast, among UC patients, race and insurance only impacted blood transfusion requirements. More studies are required to understand reasons for the effects of race, insurance, and income on healthcare outcomes of IBD patients with HACs. Table 1
Colectomy in Adults With Ulcerative Colitis Varies by Race and Payer Status Darrell M. Gray, Peter P. Stanich, Hisham Hussan, Kyle Porter, Mohamed Naem, Cheng Zhang, Edward J. Levine, Darwin Conwell, Razvan Arsenescu Background:Racial and ethnic disparities in operative outcomes among patients with chronic disease have been reported. However, little is known about potential disparities surgical treatment and outcomes among adults with ulcerative colitis (UC) undergoing colectomy. Aim:1) To characterize differences in preoperative intervals and rates of colectomy, postoperative complications and in-hospital mortality among hospitalized adults with UC and 2) determine predictors of colectomy. Methods:We analyzed discharge data on patients between 18-80 years of age who were hospitalized between 2007-2012 from the Nationwide Inpatient Sample. Patients with either a primary diagnosis of UC or a primary diagnosis of a complication of UC and a secondary diagnosis of UC were included. Patients who were admitted electively for an operation on the same day of admission were excluded. Demographic variables were compared across race/ethnicity using ANOVA or chi-square, as appropriate. ANOVA models were used to compare preoperative intervals. Colectomy rates and postoperative complications were compared using poisson regression. Multivariable logistic regression models were used to identify predictors of colectomy. Results:There were 56,690 discharges with UC. Among patients who underwent a colectomy, the mean preoperative interval was significantly longer among African Americans (8.5 days; p<0.001) and Hispanics (7.6 days; p<0.001) as compared to Whites (6.5 days). Additionally, the colectomy rate was lower among African Americans (4.9 per 1000 hospital days; p<0.001), Hispanics (7.8/1000 hospital days; p<0.001), and Asians (7.0/1000 hospital days; p<0.05) compared to Whites (11.6/1000 hospital days). This is consistent with findings in the logistic regression model that African Americans (OR 0.36, 95%CI 0.26-0.51), Hispanics (OR 0.62, 95%CI 0.430.88), and Asians (OR 0.42, 95% 0.20-0.86) were less likely to undergo colectomy. Other predictors of not undergoing colectomy included female sex (OR 0.67, 95%CI 0.58-0.78) and having either Medicaid (OR 0.62, 95%CI 0.45-0.86) or no insurance (OR 0.34, 95%CI 0.21-0.55). However, when analysis was restricted to the subgroup of patients with UC complications, only African American race and Medicaid remained significant predictors. Interestingly, while Whites had significantly higher post-operative complication rates than all other groups (4.3/1000 hospital days; p<0.05), there were no differences in-hospital mortality rates between groups. Conclusions:Colectomy rates and preoperative intervals among hospitalized adults with UC vary significantly by race/ethnicity and payer. However, this does not appear to impact post-operative complication and in-hospital mortality rates. Further study is needed to understand the etiology of this variation and examine if it correlates with differences in medical management and long-term outcomes. Mo1065 Surgical Management of Hospitalized Adults With Crohn's Disease Varies by Race and Payer Status Darrell M. Gray, Hisham Hussan, Peter P. Stanich, Kyle Porter, Mohamed Naem, Cheng Zhang, Edward J. Levine, Darwin Conwell, Razvan Arsenescu Background: Racial and ethnic disparities in operative outcomes among patients with chronic disease have been reported. However, little is known about potential disparities in surgical treatment and outcomes among adults with Crohn's disease (CD) disease undergoing bowel resection. Aim: 1) To characterize differences in preoperative intervals and rates of bowel resection, postoperative complications and in-hospital mortality among hospitalized adults with CD and 2) determine predictors of bowel resection. Methods: We analyzed discharge data on patients between 18-80 years of age who were hospitalized between 2007-2012 from the Nationwide Inpatient Sample. Patients with either a primary diagnosis of CD or a primary diagnosis of a complication of CD and a secondary diagnosis of CD were included. Patients who were admitted electively for an operation on the same day of admission were excluded. Demographic variables were compared across race/ethnicity using ANOVA or chisquare. ANOVA models were used to compare preoperative intervals. Resection rates and postoperative complication rates were compared using poisson regression. Multivariable logistic regression models were used to identify predictors of bowel resection. Results: There were 158,853 discharges with CD. Among patients who underwent a bowel resection, the mean preoperative interval was significantly longer among African Americans (4.7 days; p<0.001), Hispanics (5.0 days; p<0.01), and Asians (5.6 days; p<0.05) as compared to Whites (4.1 days). Additionally, the bowel resection rate was lower among African Americans (15.6/1000 hospital days; p<0.001), Hispanics (13.2/1000 hospital days; p<0.001), and Asians (13.1/1000 hospital days; p<0.05) compared to Whites (18.4/1000 hospital days). This is consistent with findings in the regression model that African Americans (OR 0.80, 95%CI 0.69-0.92), Hispanics (OR 0.74, 95%CI 0.60-0.92), and Asians (OR 0.62, 95% CI 0.40-0.96) were less likely to undergo bowel resection. Other predictors of not undergoing bowel resection included having Medicare (OR 0.66, 95%CI 0.57-0.76) or no insurance (OR 0.69, 95%CI 0.57-0.83). However, these differences did not persist when analysis was restricted to the subgroup of patients with CD complications. Interestingly, while Whites had significantly higher post-operative complication rates than all other groups (9.1/1000 hospital days; p<0.05), there were no differences in-hospital mortality rates between groups. Conclusions: Bowel resection rates and preoperative intervals among hospitalized adults with CD vary significantly by race/ethnicity and payer. However, this does not appear to impact post-operative complication and in-hospital mortality rates. Further study is needed to determine the etiology of this variation and examine if it correlates with differences in medical management and long-term outcomes.
Multivariate logistic or linear regression analysis of HACs impact on in-hospital mortality, length of stay (LOS), total hospital charge, and frequencies of receiving blood transfusion and parental nutrition in ulcerative colitis (UC) and Crohn's disease (CD) patients. Inhospital mortality and frequencies of receiving blood products and parental nutrition were expressed as odds ratio (OR) and 95% confidence interval (CI). LOS and total hospital charge were expressed as % increase and p-value. * The aOR and 95%CI of mortality for UC patients were not obtained because no UC patients with HACs died. Table 2
Multivariate logistic or linear regression analysis of race, insurance, and income impacts on LOS, total hospital charge, and frequency of receiving blood products on Crohn's disease (CD) or ulcerative colitis (UC) patients with HACs. The aOR of race was obtained when Black or Hispanic was compared with White. The aOR of Insurance was obtained when
AGA Abstracts
S-594
patients with Medicare were compared with patients with private insurance. The aOR of income was obtained when patients with high income were compared with patients with low income.
AGA Abstracts
Impact of Race, Income and Health Insurance on Healthcare Outcomes of Hospital Acquired Conditions (HACs) in Inflammatory Bowel Disease (IBD) Patients: A Nationwide Population-Based Study Kenneth Obi, Razvan Arsenescu, Alice Hinton, Cheng Zhang
Mo1064
Background: Crohn's disease (CD) and ulcerative colitis (UC) are chronically relapsing conditions that frequently require hospitalization. In 2008, the Centers for Medicare and Medicaid Services (CMS) identified 10 categories of preventable conditions that were considered to be HACs, for which reimbursement would not be provided. Objective: To determine the impact of race, income and health insurance on healthcare outcomes of hospitalized IBD patients who experienced HACs in the United States. Methods: This was a cross-sectional study using data from the Nationwide Inpatient Sample (NIS, 2012). IBD hospitalizations and HACs were identified using appropriate ICD-9-CM codes. We excluded patients under the age of 19 and those who carried the diagnoses of both UC and CD. We excluded HACs that were related to surgical procedures. The presence of HAC was defined as having at least one qualifying complications as listed by the CMS. The grades of income were determined based on the ZIP codes of patient's residence. Primary outcomes were in-hospital mortality, length of stay (LOS) and hospital charge. Secondary outcomes were frequency of blood transfusions and parenteral nutrition. All analyses were conducted with SAS, version 9.3, Cary, NC. Results: In 2012, there were a total of 63,845 CD discharges; of those, 290 experienced at least 1 HAC. In CD patients, HACs were associated with increased LOS, hospital charge, mortality, and blood product transfusion. In the UC population, there were 32,720 discharges with 255 patients experiencing HACs. HACs were associated with increased blood product transfusion in UC patients (Table 1). When compared with white patients, black CD patients with HACs had prolonged LOS, increased hospital charge, and increased transfusion needs. In UC patients with HACs, black patients had more blood transfusions. Hispanic patients had more hospital charge than white patients in both CD and UC groups. When compared with patients with private insurance, Medicare CD patients with HACs had prolonged LOS and Medicare UC patients with HACs were more likely to receive blood products. In CD patients with HACs, patients with high income had more hospital charges (Table 2). Conclusion: In patients with CD, HACs were associated with increased mortality and healthcare resource utilization (LOS, hospital charge, and blood transfusion). In patients with UC, HACs were only associated with increased frequency of blood transfusion. Healthcare utilization of CD patients with HACs was significantly impacted by race, insurance, and income. In contrast, among UC patients, race and insurance only impacted blood transfusion requirements. More studies are required to understand reasons for the effects of race, insurance, and income on healthcare outcomes of IBD patients with HACs. Table 1
Colectomy in Adults With Ulcerative Colitis Varies by Race and Payer Status Darrell M. Gray, Peter P. Stanich, Hisham Hussan, Kyle Porter, Mohamed Naem, Cheng Zhang, Edward J. Levine, Darwin Conwell, Razvan Arsenescu Background:Racial and ethnic disparities in operative outcomes among patients with chronic disease have been reported. However, little is known about potential disparities surgical treatment and outcomes among adults with ulcerative colitis (UC) undergoing colectomy. Aim:1) To characterize differences in preoperative intervals and rates of colectomy, postoperative complications and in-hospital mortality among hospitalized adults with UC and 2) determine predictors of colectomy. Methods:We analyzed discharge data on patients between 18-80 years of age who were hospitalized between 2007-2012 from the Nationwide Inpatient Sample. Patients with either a primary diagnosis of UC or a primary diagnosis of a complication of UC and a secondary diagnosis of UC were included. Patients who were admitted electively for an operation on the same day of admission were excluded. Demographic variables were compared across race/ethnicity using ANOVA or chi-square, as appropriate. ANOVA models were used to compare preoperative intervals. Colectomy rates and postoperative complications were compared using poisson regression. Multivariable logistic regression models were used to identify predictors of colectomy. Results:There were 56,690 discharges with UC. Among patients who underwent a colectomy, the mean preoperative interval was significantly longer among African Americans (8.5 days; p<0.001) and Hispanics (7.6 days; p<0.001) as compared to Whites (6.5 days). Additionally, the colectomy rate was lower among African Americans (4.9 per 1000 hospital days; p<0.001), Hispanics (7.8/1000 hospital days; p<0.001), and Asians (7.0/1000 hospital days; p<0.05) compared to Whites (11.6/1000 hospital days). This is consistent with findings in the logistic regression model that African Americans (OR 0.36, 95%CI 0.26-0.51), Hispanics (OR 0.62, 95%CI 0.430.88), and Asians (OR 0.42, 95% 0.20-0.86) were less likely to undergo colectomy. Other predictors of not undergoing colectomy included female sex (OR 0.67, 95%CI 0.58-0.78) and having either Medicaid (OR 0.62, 95%CI 0.45-0.86) or no insurance (OR 0.34, 95%CI 0.21-0.55). However, when analysis was restricted to the subgroup of patients with UC complications, only African American race and Medicaid remained significant predictors. Interestingly, while Whites had significantly higher post-operative complication rates than all other groups (4.3/1000 hospital days; p<0.05), there were no differences in-hospital mortality rates between groups. Conclusions:Colectomy rates and preoperative intervals among hospitalized adults with UC vary significantly by race/ethnicity and payer. However, this does not appear to impact post-operative complication and in-hospital mortality rates. Further study is needed to understand the etiology of this variation and examine if it correlates with differences in medical management and long-term outcomes. Mo1065 Surgical Management of Hospitalized Adults With Crohn's Disease Varies by Race and Payer Status Darrell M. Gray, Hisham Hussan, Peter P. Stanich, Kyle Porter, Mohamed Naem, Cheng Zhang, Edward J. Levine, Darwin Conwell, Razvan Arsenescu Background: Racial and ethnic disparities in operative outcomes among patients with chronic disease have been reported. However, little is known about potential disparities in surgical treatment and outcomes among adults with Crohn's disease (CD) disease undergoing bowel resection. Aim: 1) To characterize differences in preoperative intervals and rates of bowel resection, postoperative complications and in-hospital mortality among hospitalized adults with CD and 2) determine predictors of bowel resection. Methods: We analyzed discharge data on patients between 18-80 years of age who were hospitalized between 2007-2012 from the Nationwide Inpatient Sample. Patients with either a primary diagnosis of CD or a primary diagnosis of a complication of CD and a secondary diagnosis of CD were included. Patients who were admitted electively for an operation on the same day of admission were excluded. Demographic variables were compared across race/ethnicity using ANOVA or chisquare. ANOVA models were used to compare preoperative intervals. Resection rates and postoperative complication rates were compared using poisson regression. Multivariable logistic regression models were used to identify predictors of bowel resection. Results: There were 158,853 discharges with CD. Among patients who underwent a bowel resection, the mean preoperative interval was significantly longer among African Americans (4.7 days; p<0.001), Hispanics (5.0 days; p<0.01), and Asians (5.6 days; p<0.05) as compared to Whites (4.1 days). Additionally, the bowel resection rate was lower among African Americans (15.6/1000 hospital days; p<0.001), Hispanics (13.2/1000 hospital days; p<0.001), and Asians (13.1/1000 hospital days; p<0.05) compared to Whites (18.4/1000 hospital days). This is consistent with findings in the regression model that African Americans (OR 0.80, 95%CI 0.69-0.92), Hispanics (OR 0.74, 95%CI 0.60-0.92), and Asians (OR 0.62, 95% CI 0.40-0.96) were less likely to undergo bowel resection. Other predictors of not undergoing bowel resection included having Medicare (OR 0.66, 95%CI 0.57-0.76) or no insurance (OR 0.69, 95%CI 0.57-0.83). However, these differences did not persist when analysis was restricted to the subgroup of patients with CD complications. Interestingly, while Whites had significantly higher post-operative complication rates than all other groups (9.1/1000 hospital days; p<0.05), there were no differences in-hospital mortality rates between groups. Conclusions: Bowel resection rates and preoperative intervals among hospitalized adults with CD vary significantly by race/ethnicity and payer. However, this does not appear to impact post-operative complication and in-hospital mortality rates. Further study is needed to determine the etiology of this variation and examine if it correlates with differences in medical management and long-term outcomes.
Multivariate logistic or linear regression analysis of HACs impact on in-hospital mortality, length of stay (LOS), total hospital charge, and frequencies of receiving blood transfusion and parental nutrition in ulcerative colitis (UC) and Crohn's disease (CD) patients. Inhospital mortality and frequencies of receiving blood products and parental nutrition were expressed as odds ratio (OR) and 95% confidence interval (CI). LOS and total hospital charge were expressed as % increase and p-value. * The aOR and 95%CI of mortality for UC patients were not obtained because no UC patients with HACs died. Table 2
Multivariate logistic or linear regression analysis of race, insurance, and income impacts on LOS, total hospital charge, and frequency of receiving blood products on Crohn's disease (CD) or ulcerative colitis (UC) patients with HACs. The aOR of race was obtained when Black or Hispanic was compared with White. The aOR of Insurance was obtained when
AGA Abstracts
S-594