Socioeconomic and other predictors of colonoscopy preparation quality.
BACKGROUND
Suboptimal bowel preparation prior to colonoscopy is a common occurrence, with a deleterious impact on colonoscopy effectiveness. Established risk factors for suboptimal bowel preparation have been proposed, but social factors, such as socioeconomic status and marital status, have not been investigated.


OBJECTIVE
The aim of this study was to evaluate sociodemographic factors, including insurance status and marital status, as predictive of suboptimal preparation.


METHODS
We analyzed a database of 12,430 consecutive colonoscopies during a 28-month period at Columbia University Medical Center. We collected the following variables: age, gender, indication for colonoscopy, location (inpatient vs. outpatient), race, marital status, and Medicaid status. Preparation quality was recorded and dichotomized as optimal or suboptimal. We employed multivariate regression to determine independent risk factors for suboptimal bowel preparation.


RESULTS
Among the 10,921 examinations in which bowel preparation was recorded, suboptimal preparation occurred in 34% of Medicaid patients versus 18% of non-Medicaid patients (P < 0.0001); this remained significant in the multivariate analysis (odds ratio (OR) 1.84, 95% CI 1.61-2.11). Married patients had decreased rates of suboptimal preparation (OR 0.89, 95% CI 0.80-0.98). Other variables associated with suboptimal preparation included increased age (OR per 10 years 1.09, 95% CI 1.05-1.14), male gender (OR 1.44, 95% CI 1.31-1.59), inpatient status (OR 1.51, 95% CI 1.26-1.80), and later time of day (OR 1.89, 95% CI 1.71-2.09).


CONCLUSIONS
Unmarried status and Medicaid status are predictive of suboptimal bowel preparation. Future studies are warranted to identify how these social conditions predict bowel preparation quality and to implement interventions to optimize bowel preparation in vulnerable populations.
Lebwohl
Benjamin
B
Division of Digestive and Liver Disease, Columbia University, New York, NY 10032, USA. BL114@columbia.edu
Wang
Timothy C
TC
Neugut
Alfred I
AI
D000046:Academic Medical Centers; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002400:Cathartics / Q000008:administration & dosage* / Q000191:economics; D015331:Cohort Studies; D003113:Colonoscopy / Q000191:economics / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis; D008297:Male; D008484:Medicaid / Q000191:economics*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011786:Quality Control; D012189:Retrospective Studies; D012307:Risk Factors; D012847:Single Person; D012959:Socioeconomic Factors; D007507:Therapeutic Irrigation / Q000191:economics / Q000592:standards* / Q000639:trends; D014481:United States
D002400:Cathartics