Disparities in access to minimally invasive surgery for inflammatory bowel disease and outcomes by insurance status: analysis of the 2015 to 2019 National Inpatient Sample

Lee, Yung; Andrew, Lauren; Hill, Sarah; An, Kevin R.; Chatroux, Louisa; Anvari, Sama; Hong, Dennis; Kuhnen, Angela H.

doi:10.1007/s00464-023-10400-7

Cited by 4 publications

(1 citation statement)

References 32 publications

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“…A total of 41 studies (61.2%) compared the rates or frequency of bowel surgery between males and females [ 25 , 26 , 33 – 71 ]. Of these, 22 (53.7%) reported statistically significant sex-based differences in the likelihood of bowel surgery [ 25 , 26 , 33 , 35 , 39 , 40 , 44 , 47 , 50 – 53 , 55 , 56 , 58 , 62 – 64 , 66 , 67 , 69 , 70 ] (Table 1 ). Of these 22 studies, 19 reported that males had a higher likelihood of bowel surgery than females.…”

Section: Resultsmentioning

confidence: 99%

Impact of sex and socioeconomic status on the likelihood of surgery, hospitalization, and use of medications in inflammatory bowel disease: a systematic review and meta-analysis

Rasmussen,

Moos,

Gregersen

et al. 2024

Syst Rev

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Background Inflammatory bowel diseases (IBDs) are associated with high healthcare utilization. This systematic review aimed to summarize what is known about the impact of sex, income, and education on the likelihood of bowel surgery, hospitalization, and use of corticosteroids and biologics among patients with IBD. Methods We used EMBASE, MEDLINE, CINAHL, and Web of Science to perform a systematic literature search. Pooled hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random effects meta-analysis for the impact of sex on the likelihood of surgery and hospitalization. In addition, we performed subgroup analyses of the effect of IBD type (Crohn’s disease or ulcerative colitis) and age. Finally, meta-regression was undertaken for the year of publication. Results In total, 67 studies were included, of which 23 studies were eligible for meta-analysis. In the main meta-analysis, male sex was associated with an increased likelihood of bowel surgery (HR 1.42 (95% CI 1.13;1.78), which was consistent with the subgroup analysis for UC only (HR 1.78, 95% CI 1.16; 2.72). Sex did not impact the likelihood of hospitalization (OR 1.05 (95% CI 0.86;1.30), although the subgroup analysis revealed an increased likelihood of hospitalization in CD patients (OR 1.42, 95% CI 1.28;1.58). In 9 of 10 studies, no significant sex-based differences in the use of biologics were reported, although in 6 of 6 studies, female patients had lower adherence to biologics. In 11 of 13 studies, no significant sex-based difference in the use of corticosteroids was reported. The evidence of the impact of income and education on healthcare utilization was sparse and pointed in different directions. The substantial heterogeneity between studies was explained, in part, by differences in IBD type and age. Conclusions The results of this systematic review indicate that male patients with IBD are significantly more likely to have surgery than female patients with IBD but are not, overall, more likely to be hospitalized, whereas female patients appear to have statistically significantly lower adherence to biologics compared to male patients. Thus, clinicians should not underestimate the impact of sex on healthcare utilization. Evidence for income- and education-based differences remains sparse. Systematic review registration PROSPERO CRD42022315788.

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Section: Resultsmentioning

confidence: 99%

Impact of sex and socioeconomic status on the likelihood of surgery, hospitalization, and use of medications in inflammatory bowel disease: a systematic review and meta-analysis

Rasmussen,

Moos,

Gregersen

et al. 2024

Syst Rev

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Utilization of minimally invasive colectomy at safety-net hospitals in the United States

Branche,

Sakowitz,

Porter

et al. 2024

Surgery

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Closing the Gap: Approaches to Improving Colorectal Surgery Care for the Uninsured and Underinsured

Isenberg,

Harbaugh

2024

Clin Colon Rectal Surg

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Health insurance plays a critical role in access to and delivery of health care in the United States. As the only industrialized nation without universal health coverage, Americans without adequate insurance (i.e., uninsured or underinsured individuals) face numerous obstacles to obtaining necessary health care. In this article, we review the mechanisms by which inadequate insurance leads to worse clinical outcomes in patients with common benign and malignant colorectal pathologies. We then discuss several evidence-based solutions for improving access to optimal colorectal care for these patients. These include increasing access to and affordability of health insurance, mitigating disparities between differently insured populations, strengthening the health care safety net, and tailoring outreach and clinical decision-making for the uninsured and underinsured. By exploring the nuance and impact of inadequate insurance coverage, we ultimately seek to highlight critical opportunities for future research and advocacy within the realm of insurance design and policy.

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Disparities in access to minimally invasive surgery for inflammatory bowel disease and outcomes by insurance status: analysis of the 2015 to 2019 National Inpatient Sample

Cited by 4 publications

References 32 publications

Impact of sex and socioeconomic status on the likelihood of surgery, hospitalization, and use of medications in inflammatory bowel disease: a systematic review and meta-analysis

Impact of sex and socioeconomic status on the likelihood of surgery, hospitalization, and use of medications in inflammatory bowel disease: a systematic review and meta-analysis

Utilization of minimally invasive colectomy at safety-net hospitals in the United States

Closing the Gap: Approaches to Improving Colorectal Surgery Care for the Uninsured and Underinsured

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