title: Insurance but not race is associated with diverticulitis mortality in a statewide database.
abstract: OBJECTIVE
  Racial identity and health insurance have been associated with differential health care outcomes for many diseases, but not for diverticulitis. We examined the association of racial identity and insurance with admission, treatment, and mortality for patients admitted to inpatient care for acute diverticulitis.
  
  
  METHODS
  Data on adult inpatients with nonelective diverticulitis admissions between 1985 and 2006 were extracted from the New York Statewide Planning and Cooperative Systems Database. Race categories were white non-Hispanic, black non-Hispanic, Hispanic, Asian, other race, and unknown race. A multivariable logistic regression model adjusted for insurance, year, patient factors, community factors, and hospital factors was used to examine the association of racial identity and insurance with presentation, treatment, and mortality. Five outcomes were considered: 1) admission via the emergency department, 2) complicated disease presentation, 3) surgical intervention, 4) colostomy creation, and 5) mortality. White race and private insurance were reference groups.
  
  
  RESULTS
  We identified 253,655 admissions. Race distribution included 77.7% white, 8.1% black, and 7.2% Hispanic. Medicare was the most commonly held insurance (52.7%), and 73.7% of patients were admitted through the emergency department. Of 36,190 surgeries, 20,650 (57.1%) included colostomies, and 3.0% of all patients died. Race other than white and Medicaid insurance were the strongest predictors of admission via the emergency department (OR 1.34, 95% CI 1.12-1.60; OR 1.60, 95% CI 1.44-1.78). Patients categorized as black, Hispanic, Asian, or other were less likely to have complicated disease, surgery, and colostomy creation (OR 0.81, 95% CI 0.76-0.85; OR 0.87, 95% CI 0.81-0.94; and OR 0.67, 95% CI 0.61-0.74). Insurance was associated with higher rates of mortality; having Medicaid or no insurance were the strongest predictors (OR 1.61, 95% CI 1.36-1.89; OR 1.34, 95% CI 1.06-1.69).
  
  
  CONCLUSIONS
  In acute diverticulitis, race and insurance were associated with differential admission patterns, and patients categorized as black, Hispanic, Asian, or other were less likely to receive surgical treatment or colostomy. Insurance status, but not race, was associated with mortality. Future research is needed to further explore these differences in admission, treatment, and mortality.
authors.affiliation: Department of Surgery, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Vanessa P
authors.initials: VP
authors.lastname: Ho
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Nash
authors.forename: Evan N
authors.initials: EN
authors.lastname: Feldman
authors.forename: Koiana
authors.initials: K
authors.lastname: Trencheva
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Milsom
authors.forename: Sang W
authors.initials: SW
authors.lastname: Lee
mesh_terms: D004238:Diverticulitis / Q000191:economics / Q000208:ethnology / Q000401:mortality*; D005260:Female; D006301:Health Services Needs and Demand / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage / Q000639:trends*; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D044469:Racial Groups; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D015996:Survival Rate / Q000639:trends