title: Racial and Socioeconomic Disparities in Gastrostomy Tube Placement After Intracerebral Hemorrhage in the United States.
abstract: OBJECTIVE
  Percutaneous endoscopic gastrostomy (PEG) tubes are widely used for enteral feeding of patients after intracerebral hemorrhage (ICH). We sought to determine whether PEG placement after ICH differs by race and socioeconomic status.
  
  
  METHODS
  Patient discharges with ICH as the primary diagnosis from 2007 to 2011 were queried from the Nationwide Inpatient Sample. Logistic regression was used to evaluate the association between race, insurance status, and household income with PEG placement.
  
  
  RESULTS
  Of 49 946 included ICH admissions, a PEG was placed in 4464 (8.94%). Among PEG recipients, 47.2% were minorities and 15.6% were Medicaid enrollees, whereas 33.7% and 8.2% of patients without a PEG were of a race other than white and enrolled in Medicaid, respectively (P<0.001). Compared with whites, the odds of PEG were highest among Asians/Pacific Islanders (odds ratio [OR] 1.62, 95% confidence interval [CI] 1.32-1.99) and blacks (OR 1.42, 95% CI 1.28-1.59). Low household income (OR 1.25, 95% CI 1.09-1.44 in lowest compared with highest quartile) and enrollment in Medicaid (OR 1.36, 95% CI 1.17-1.59 compared with private insurance) were associated with PEG placement. Racial disparities (minorities versus whites) were most pronounced in small/medium-sized hospitals (OR 1.77, 95% CI 1.43-2.20 versus OR 1.31, 95% CI 1.17-1.47 in large hospitals; P value for interaction 0.011) and in hospitals with low ICH case volume (OR 1.58, 95% CI 1.38-1.81 versus OR 1.29, 95% CI 1.12-1.50 in hospitals with high ICH case volume; P value for interaction 0.007).
  
  
  CONCLUSIONS
  Minority race, Medicaid enrollment, and low household income are associated with PEG placement after ICH.
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD. rfaigle1@jhmi.edu.
authors.forename: Roland
authors.initials: R
authors.lastname: Faigle
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Mona N
authors.initials: MN
authors.lastname: Bahouth
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Victor C
authors.initials: VC
authors.lastname: Urrutia
authors.affiliation: From the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000601:surgery*; D016208:Databases, Factual; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy; D054625:Healthcare Disparities; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States; D044465:White People
keywords: PEG; disparities; feeding tube; gastrostomy tube; intracerebral hemorrhage; socioeconomic status