title: Race and socioeconomic disparities in national stoma reversal rates.
abstract: BACKGROUND
  Many temporary stomas are never reversed leading to significantly worse quality of life. Recent evidence suggests a lower rate of reversal among minority patients. Our study aimed to elucidate disparities in national stoma closure rates by race, medical insurance status, and household income.
  
  
  METHODS
  Five years of data from the Nationwide Inpatient Sample (2008 to 2012) was used to identify the annual rates of stoma formation and annual rates of stoma closure. Stomas labeled as "permanent" or those created secondary to colorectal cancers were excluded. Temporary stoma closure rates were calculated, and differences were tested with the chi-square test. Separate analyses were performed by race/ethnicity, insurance status, and household income. Nationally representative estimates were calculated using discharge-level weights.
  
  
  RESULTS
  The 5-year average annual rate of temporary stoma creation was 76,551 per year (46% colostomies and 54% ileostomies). The annual rate of stoma reversal was 50,155 per year that equated to an annual reversal rate of 65.5%. Reversal rates were higher among white patients compared with black patients (67% vs 56%, P < .001) and among privately insured patients compared with uninsured patients (88% vs 63%, P < .001). Reversal rates increased as the household income increased from 61% in the lowest income quartile to 72% in the highest quartile (P < .001).
  
  
  CONCLUSIONS
  Stark disparities exist in national rates of stoma closure. Stoma closure is associated with race, insurance, and income status. This study highlights the lack of access to surgical health care among patients of minority race and low-income status.
authors: Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA. Electronic address: zafar.nabeel@gmail.com.
authors: Syed Nabeel
authors: SN
authors: Zafar
authors: Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
authors: Navin R
authors: NR
authors: Changoor
authors: Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA.
authors: Kibileri
authors: K
authors: Williams
authors: Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA.
authors: Rafael D
authors: RD
authors: Acosta
authors: Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA.
authors: Wendy R
authors: WR
authors: Greene
authors: Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA.
authors: Terrence M
authors: TM
authors: Fullum
authors: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
authors: Adil H
authors: AH
authors: Haider
authors: Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA.
authors: Edward E
authors: EE
authors: Cornwell
authors: Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA.
authors: Daniel D
authors: DD
authors: Tran
mesh_terms: D000367:Age Factors; D000368:Aged; D003125:Colostomy / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D007081:Ileostomy / Q000401:mortality / Q000706:statistics & numerical data*; D007182:Income / Q000706:statistics & numerical data*; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
keywords: Access to health care; Health care disparities; Ostomy; Stoma reversal; Surgery