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Uninsured Face Worse Outcomes After Diverticulitis
Date:12/15/2008

Delaying care, they may present with more complications, experts say

MONDAY, Dec. 15 (HealthDay News) -- Patients lacking adequate health insurance are more like to fare poorly after a diagnosis of the painful and sometimes deadly intestinal condition known as diverticulitis, a new study finds.

In fact, insurance status may explain long-observed disparities in outcomes between black and white patients with the ailment, the researchers say.

"Uninsured patients are more likely to present in a more complicated status," meaning that they have delayed seeking treatment, said David C. Chang, an assistant professor of surgery at Johns Hopkins University and senior author of a report in the December issue of the Archives of Surgery.

In fact, he said, "Uninsured patients are 164 percent more likely to die after [diverticulitis] surgery than insured patients."

Diverticulitis involves the inflammation and infection of small pockets that form in the intestine. Complications of the condition include bowel obstruction, hemorrhage or perforation of the intestine. More than 200,000 Americans are hospitalized each year for diverticulitis, which becomes more common as people age. It accounts for more than $300 million in U.S. health costs each year.

Diverticulitis is also one of many conditions for which poorer results have been reported for blacks than for whites.

However, the Johns Hopkins analysis of nationwide data found that "insurance is a bigger issue than race," said Chang.

Chang was a member of a group led by Dr. Anne O. Lidor, an assistant professor of surgery at Hopkins. Her team studied information on more than 45,500 people treated for diverticulitis between 1999 and 2003.

Race was not associated with the type of surgical treatment received for diverticulitis, the researchers reported.

"In contrast, insurance status did correlate with the type of treatment provided," they wrote. "Uninsured and underinsured patients were more likely to receive a colostomy -- even after adjusting for a higher rate of complicated diverticulitis [seen] in those patients than their insured counterparts."

Colostomy is the creation of a surgical opening through the abdominal wall to allow for waste removal.

The study results have wide implications for health policy, Chang said.

"A racial disparity in diverticulitis outcomes has been described for decades," he said. "But African-American patients are less likely to be insured. What this is showing is that insurance is a contributor to the disparity in racial outcomes."

The Hopkins group has done a similar study of trauma patients -- it found the same effect of health insurance status on patient outcomes, Chang noted. These studies should be considered when national health plans are being drawn up, he said, since it now appears that "[having] insurance can ameliorate the effect of race."

"The policy implication is that when you don't see equal care, we should focus on designing interventions to get equal care," added Dr. Selwyn O. Rogers Jr., an associate professor of surgery at Harvard Medical School and Brigham and Women's Hospital, who wrote an accompanying commentary on the study.

Someone who has a single episode of diverticulitis is likely to have recurrences, Rogers noted.

"If you have an excellent health insurance plan, you get referred to helpful surgeons and high-quality hospitals," he said. "Hopefully, you don't present with the kind of complications that might require colostomy."

About one in five Americans in a 2007 survey reported either delaying needed medical treatment or foregoing it altogether, Rogers noted in his commentary. "This dramatic decline in access to both medical and surgical care is alarming," he wrote.

More information

There's more on diverticulitis, its symptoms and treatment, at the U.S. Library of Medicine.



SOURCES: David C. Chang, Ph.D, assistant professor, surgery, Johns Hopkins University, Baltimore; Selwyn O. Rogers, Jr., M.D., associate professor, surgery, Harvard Medical School and Brigham and Women's Hospital, Boston; December 2008 Archives of Surgery


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