title: Socioeconomic Inequalities in the Utilization of Colorectal Stents for the Treatment of Malignant Bowel Obstruction.
abstract: Colorectal stents are increasingly employed as a bridge to surgery or for palliative relief of malignant large bowel obstruction.
  
  
  
  To explore determinants of inpatient colorectal stent utilization (CRSU).
  
  
  
  An analysis of the 2012 National Inpatient Sample was performed. International Classification of Diseases, 9th revision, codes were used to identify discharges associated with CRSU and patient/hospital factors for inclusion in a logistic regression model.
  
  
  
  We identified 217,055 inpatient colonoscopies, approximating 1.1 million inpatient colonoscopies nationwide. Colorectal stents were placed in 1.4 % of all procedures. Across all racial groups, Medicare was the most common payer. Patients with commercial insurance had lower CRSU compared with Medicare patients [adjusted odds ratio (OR) 0.83, 95 % confidence interval (CI) 0.75-0.92]. No gender disparities were identified (OR 0.96, 95 % CI 0.89-1.03). In addition, no racial differences in CRSU existed between Caucasians versus African-Americans (OR 0.94, 95 % CI 0.83-1.06) and Caucasians versus Hispanics (OR 0.96, 95 % CI 0.83-1.1). Compared with patients living in less affluent neighborhoods, those residing in more affluent areas had higher CRSU (OR 1.65, 95 % CI 1.46-1.86). This displayed a linear relationship with the odds of CRSU increasing as household income increased. Less affluent patients also had the highest total charges and longest wait time to CRSU. CRSU was highest among patients treated in larger medical centers (OR 1.7, 95 % CI 1.51-1.93) and teaching hospitals (OR 3.9, 95 % CI 3.2-4.8).
  
  
  
  Individuals from less affluent neighborhoods have lower colorectal stent utilization. This disparity is independent of race and likely related to poorer access to healthcare resources.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. okafor.philip@mayo.edu.
authors.forename: Philip N
authors.initials: PN
authors.lastname: Okafor
authors.affiliation: North Shore University Health System, 4901 Searle Pkwy, Skokie, IL, 60077, USA.
authors.forename: Derrick J
authors.initials: DJ
authors.lastname: Stobaugh
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Louis M
authors.initials: LM
authors.lastname: Wong Kee Song
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Limburg
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.|Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Jayant A
authors.initials: JA
authors.lastname: Talwalkar
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000150:complications* / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D015607:Stents / Q000191:economics*; D014481:United States
keywords: Disparities; Healthcare resource utilization; Palliative endoscopy; Self-expanding metal stents