Disparities in Utilization of Medical Specialists for Colonoscopy

Michele J Josey; Cassie L Odahowski; Whitney E Zahnd; Mario Schootman; Jan M Eberth

doi:10.1089/heq.2019.0052

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Disparities in Utilization of Medical Specialists for Colonoscopy

Journal article

Open access

Peer reviewed

Disparities in Utilization of Medical Specialists for Colonoscopy

Michele J Josey, Cassie L Odahowski, Whitney E Zahnd, Mario Schootman and Jan M Eberth

Health equity, Vol.3(1), pp.464-471

09/01/2019

DOI: 10.1089/heq.2019.0052

PMCID: PMC6729104

PMID: 31501806

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Abstract

Purpose: Colonoscopy is the preferred screening modality for colorectal cancer (CRC) prevention. The quality of the procedure varies although medical specialists such as gastroenterologists and colorectal surgeons tend to have better outcomes. We aimed to determine whether there are demographic and clinical differences between those who received a colonoscopy from a specialist versus those who received a colonoscopy from a nonspecialist. Methods: Using the population-based South Carolina Outpatient Ambulatory Surgery Database, we looked retrospectively to obtain patient-level endoscopy records from 2010 to 2014. We used multilevel logistic regression to model whether patients saw a specialist for their colonoscopy. The primary variables were patient race and insurance type, and an interaction by rurality was tested. Results: Of the 392,285 patients included in the analysis, 81% saw a specialist for their colonoscopy. County of residence explained 30% of the variability in the outcome. Non-Hispanic black (OR=0.65; confidence interval [95% CI]: 0.64–0.67) and Hispanic patients (OR=0.75; 95% CI: 0.67–0.84) were significantly less likely than non-Hispanic white patients to see a specialist. Compared with commercial/HMO insurance, all other types were less likely to see a specialist, and even more so for rural patients. The interaction of race by rurality was not significant. Conclusions: Specialists play a key role in CRC screening and can affect later downstream outcomes. This study has shown that ethnic minorities and adults with public or other insurance, particularly in rural areas, are most likely not to see a specialist. These results are consistent with disparities in CRC incidence, mortality, and survival.

Original Article

Details

Title: Subtitle: Disparities in Utilization of Medical Specialists for Colonoscopy
Creators: Michele J Josey - 3Rural and Minority Health Research Center, University of South Carolina, Columbia, South Carolina
Cassie L Odahowski - 3Rural and Minority Health Research Center, University of South Carolina, Columbia, South Carolina
Whitney E Zahnd - 3Rural and Minority Health Research Center, University of South Carolina, Columbia, South Carolina
Mario Schootman - 4Department of Clinical Analytics and Insights, Center for Clinical Excellence, SSM Health System, St. Louis, Missouri
Jan M Eberth - 3Rural and Minority Health Research Center, University of South Carolina, Columbia, South Carolina
Resource Type: Journal article
Publication Details: Health equity, Vol.3(1), pp.464-471
DOI: 10.1089/heq.2019.0052
PMID: 31501806
PMCID: PMC6729104
NLM abbreviation: Health Equity
ISSN: 2473-1242
eISSN: 2473-1242
Publisher: Mary Ann Liebert, Inc., publishers
Language: English
Date published: 09/01/2019
Academic Unit: Health Management and Policy
Record Identifier: 9984214783202771

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