Disparities in colonoscopy utilization for lower gastrointestinal bleeding in rural vs urban settings in the United States

作     者：Nagapratap Ganta Mina Aknouk Dina Alnabwani Ivan Nikiforov Veera Jayasree Latha Bommu Vraj Patel Pramil Cheriyath Christopher S Hollenbeak Alan Hamza 

作者机构：Department of Internal MedicineHackensack Meridian Health Ocean Medical CenterBrickNJ 08724United States Penn State Milton S.Hershey Medical Center500 University DriveUniversity ParkPA 16802United States Department of Internal MedicineOcala HealthOcalaFL 34471United States 

出 版 物：《World Journal of Gastrointestinal Endoscopy》 (世界胃肠内镜杂志（英文版）（电子版）)

年 卷 期：2022年第14卷第8期

页      面：474-486页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Lower gastrointestinal bleeding Rural-urban disparities Colonoscopy Utilization of colonoscopy Length of stay Inpatient admission costs 

摘      要：BACKGROUND Lower gastrointestinal bleeds(LGIB)is a very common inpatient condition in the United *** bleeds have a variety of presentations,from minor bleeding to severe hemorrhage and *** previous studies investigated the efficacy of colonoscopy in hospitalized patients with LGIB,there is limited research that discusses disparities in colonoscopy utilization in patients with LGIB in urban and rural *** To investigate the difference in utilization of colonoscopy in lower gastrointestinal bleeding between patients hospitalized in urban and rural *** This is a retrospective cohort study of 157748 patients using National Inpatient Sample data and the Healthcare Cost and Utilization Project provided by the Agency for Healthcare Research and *** includes patients 18 years and older hospitalized with LGIB admitted between 2010 and *** study does not differentiate between acute and chronic LGIB and both are included in this *** primary outcome measure of this study was the utilization of colonoscopy among patients in rural and urban hospitals admitted for lower gastrointestinal bleeds;the secondary outcome measures were in-hospital mortality,length of stay,and costs involved in those receiving colonoscopy for *** analyses were all performed using STATA *** regression was used to analyze the utilization of colonoscopy and mortality,and a generalized linear model was used to analyze the length of stay and *** Our study found that 37.9%of LGIB patients at rural hospitals compared to approximately 45.1%at urban hospitals received colonoscopy,(OR=0.730,95%CI:0.705-0.7,P0.0001).After controlling for covariates,colonoscopies were found to have a protective association with lower inhospital mortality[OR=0.498,95%CI:0.446-0.557,P0.0001],but a longer length of stay by 0.72 d(95%CI:0.677-0.759 d,P0.0001)and approximately$2199 in increased *** Although there was