Journal Article

Race and socioeconomic disparities in national stoma reversal rates

Cornwell, Edward E., Changoor, Navin R., Haider, Adil H., Acosta, Rafael D., Tran, Daniel D., Zafar, Syed Nabeel, Williams, Kibileri, Fullum, Terrence M., Greene, Wendy R.

2016

Overview

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. 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. 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). 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.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Access to health care / Age / Age Factors / Aged / Chronic illnesses / Codes / Colon / Colostomy - mortality / Colostomy - statistics & numerical data / Datasets / Estimates / Female / Gender / Health care disparities / Healthcare Disparities - ethnology / Hospitalization / Hospitals / Humans / Ileostomy - mortality / Ileostomy - statistics & numerical data / Income - statistics & numerical data / Insurance Coverage - statistics & numerical data / Male / Medicaid / Medicare / Middle Aged / Mortality / Ostomy / Quality of Life / Reoperation - statistics & numerical data / Risk Factors / Socioeconomic Factors / Standard deviation / Stoma reversal / Surgery / Uninsured people / United States - epidemiology