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Objectives Few studies have examined the role health disparities play in pediatric gastrointestinal (GI) procedures. We hypothesized that health disparity factors affect whether patients undergo an emergent vs. non-emergent GI procedure. The aims were to characterize the existing pediatric population undergoing GI procedures at our institution and assess specific risk factors associated with emergent vs. non-emergent care. Methods We retrospectively reviewed the medical records of 2,110 patients undergoing GI procedures from January 2012–December 2014. Emergent procedures were performed on an urgent inpatient basis. All other procedures were considered non-emergent. Health disparity factors analyzed included age, gender, insurance type, race, and language. Logistic regression analysis identified the odds of undergoing emergent procedures for each factor. Results Most study patients were male (58.2%), primarily insured by Medicaid (63.8%), Caucasian (44.0%), and spoke English (91.7%). 10% of all patients had an emergent procedure. Logistic regression analysis showed significant odds ratios [OR, p-value] for ages 18+ years [2.16, 0.003], females [0.62, 0.001], commercial insurance users [0.49, <0.0001], African Americans [1.94, <0.0001] and other race [1.72, 0.039]. Conclusion Health disparities in age, gender, insurance, and race appear to exist in this pediatric population undergoing GI procedures. Patients 18+ years of age, African Americans, and other races were significantly more likely to have an emergent procedure. Females and commercial insurance users were significantly less likely to have an emergent procedure. More research is necessary to understand why these relationships exist and how to establish appropriate interventions.

In a case-control study of cholecystectomy and carcinoma of the colon conducted in a residential retirement community near Los Angeles, California, no significant association was found, either for all colonic cancer (relative risk = 1.2) or by subsite (relative risk = 0.8 for right-sided colonic cancer and 1.3 for other colonic cancer). Because of this negative finding and the inconsistency of other epidemiologic studies, certain aspects of the descriptive epidemiology of colonic cancer in Los Angeles were examined to see if they were consistent with a major etiologic role for cholecystectomy. The distribution of right-sided colonic cancer by sex and race contrasted sharply with that expected, based on the known distribution of cholecystectomies in the population. Cholecystectomy is unlikely to be an important factor in the etiology of right-sided colonic cancer.

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2017-08-25T16:31:16

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