The Impact of Socioeconomic Status on Presentation and Treatment of Diverticular Disease

Abstract

INTRODUCTION: Diverticular disease is a common medical problem, but it is unknown if lower socioeconomic status (SES) affects patient outcomes in diverticular disease. MATERIAL AND METHODS: The New York (NY) State Inpatient Database was used to query 8,117 cases of diverticular disease occurring in patients aged 65-85 in 2006. Race and SES were assessed by creating a composite score based on race, primary insurance payer, and median income bracket. RESULTS: Primary outcomes were differences in disease presentation, use of elective surgery, complication rates when surgery was performed, and overall mortality and length of stay. Patients of lower SES were younger, more likely to be female, to have multiple co-morbid conditions, to present as emergent/urgent admissions, and to present with diverticulitis complicated by hemorrhage (p < 0.0001). DISCUSSION: Overall, patients of low SES were less likely to receive surgical intervention, while rates of surgery were similar in elective cases. When surgery was performed, patients of lower SES had similar complication rates (25.4% vs. 20.2%, p = 0.06) and higher overall mortality (9.0% vs. 4.4%, p = 0.003). CONCLUSION: Patients of low SES who are admitted with diverticular disease have an increased likelihood to present emergently, have worse disease on admission, and are less likely to receive surgery.