Ganta N, Aknouk M, Alnabwani D, Nikiforov I, Bommu VJL, Patel V, Cheriyath P, Hollenbeak CS, Hamza A. Disparities in colonoscopy utilization for lower gastrointestinal bleeding in rural vs urban settings in the United States. World J Gastrointest Endosc 2022; 14(8): 474-486 [PMID: 36158630 DOI: 10.4253/wjge.v14.i8.474]
Corresponding Author of This Article
Pramil Cheriyath, FACP, MBBS, MD, MS, Director, Doctor, Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, 1610 NJ-88, Brick, NJ 08724, United States. pramil.cheriyath@hmhn.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Aug 16, 2022; 14(8): 474-486 Published online Aug 16, 2022. doi: 10.4253/wjge.v14.i8.474
Disparities in colonoscopy utilization for lower gastrointestinal bleeding in rural vs urban settings in the United States
Nagapratap Ganta, Mina Aknouk, Dina Alnabwani, Ivan Nikiforov, Veera Jayasree Latha Bommu, Vraj Patel, Pramil Cheriyath, Christopher S Hollenbeak, Alan Hamza
Nagapratap Ganta, Mina Aknouk, Dina Alnabwani, Ivan Nikiforov, Veera Jayasree Latha Bommu, Vraj Patel, Pramil Cheriyath, Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, NJ 08724, United States
Christopher S Hollenbeak, Penn State Milton S. Hershey Medical Center, 500 University Drive, University Park, PA 16802, United States
Alan Hamza, Department of Internal Medicine, Ocala Health, Ocala, FL 34471, United States
Author contributions: Ganta N and Aknouk M contributed equally to this work; Ganta N, Aknouk M, Nikiforov I, Bommu VJL, Patel V, Cheriyath P, Hollenbeak C, and Hamza A, designed the research study; Ganta N, Aknouk M, Alnabwani D, Nikiforov I, Bommu VJL, Patel V, and Hollenbeak C performed the research; Hollenbeak C, Nikiforov I, and Cheriyath P contributed in statistical analysis; Ganta N, Aknouk M, Alnabwani D, Nikiforov I, Bommu VJL, Patel V, and Hollenbeak C analyzed the data and wrote the manuscript.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pramil Cheriyath, FACP, MBBS, MD, MS, Director, Doctor, Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, 1610 NJ-88, Brick, NJ 08724, United States. pramil.cheriyath@hmhn.org
Received: February 15, 2022 Peer-review started: February 15, 2022 First decision: April 12, 2022 Revised: May 14, 2022 Accepted: July 22, 2022 Article in press: July 22, 2022 Published online: August 16, 2022 Processing time: 180 Days and 16.7 Hours
ARTICLE HIGHLIGHTS
Research background
Disparities in colonoscopy access in rural and urban hospitals is an understudied topic. The significance of this study is to demonstrate whether or not improved access improves patient mortality.
Research motivation
To improve access to colonoscopies in the United States. We are also interested in the availability of colonoscopy and how it effects patients length of stay and costs.
Research objectives
To discover whether or not there is a disparity in colonoscopy utilization for lower gastrointestinal bleeds between rural and urban hospital areas in the United States. Also to determine whether there is a benefit for mortality in patients with lower gastrointestinal bleeds when they receive colonoscopies.
Research methods
Retrospective cohort study and data analysis of National Inpatient Sample, Healthcare Cost and Utilization Project, provided by the Agency for Healthcare Research and Quality.
Research results
Approximately 37.9% of patients with lower gastrointestinal bleeding received colonoscopy at rural hospitals compared to 45.1% at urban hospitals. Patients treated at rural hospitals had 27% lower odds of receiving colonoscopy relative to patients treated at urban hospitals (OR = 0.73, P < 0.0001) After controlling for other factors, colonoscopy was associated with a 50% lower odds of mortality (OR = 0.50, P < 0.0001). The problem that remains to be solved is providing patients in rural hospitals access to colonoscopy so more patients can have a mortality benefit when they present with a lower gastrointestinal bleed.
Research conclusions
This study proposes that because there is a decrease in mortality when patients receive a colonoscopy, we should improve access to colonoscopies in rural hospitals. New methods proposed are increased access to specialists and increased training opportunities for primary care providers for colonoscopies.
Research perspectives
Future research should be aimed at determining mortality differences in patients with lower gastrointestinal bleeds that receive colonoscopy between urban and rural hospitals.
