Social Determinants of Health Do Not Predict Emergent Operation for Diverticulitis

Britney L Corey, MD, Lauren E Goss, Allison A Gullick, MPH, Daniel I Chu, MD, Melanie S Morris, MD, Jayleen M Grams, MD, PhD. University of Alabama at Birmingham

Introduction: Social determinants of health (SDOH) have been associated with disparities in access to care and treatment-decisions. Emergent management of diverticular disease may be related to variations in these factors. We hypothesized that SDOH are a risk factor for emergent treatment of diverticular disease.

Methods: A retrospective review was performed on all patients who underwent an operation for diverticular disease between January 1, 2009 and December 31, 2014 at a tertiary-care academic institution. SDOH variables included marital status, insurance, and socioeconomic status (SES). SES was determined using 6 measures compared to national census data to generate a neighborhood summary Z score (Table 1). Patients were stratified by emergent versus nonemergent operation. Multivariate analysis was performed of all possible covariates including SDOH. Significance was determined as p-value ≤0.05. 

Results: Of the 182 patients who underwent an operation for diverticulitis, 54 (29.8%) were emergent and 128 (70.2%) were non-emergent. There were no differences between groups for age or marital status. Although there was a trend, there was no significant difference based on race (p=0.055). Compared to non-emergent patients, emergent patients were more likely to be male (59.3 vs 39.8%, p=0.016) and have non-private insurance (61.1 vs 36.7%, p=0.003). Distance to hospital was significantly greater for non-emergent patients compared to emergent patients (63.8 vs 43.0 miles, p=0.035). There was no significant difference between groups based on summary Z score. On multivariate analysis, marital status, insurance status, and SES score did not predict an emergent operation.

Conclusion: SDOH did not predict an increased likelihood of emergent operation for diverticular disease. Emergent operation may be based upon the severity of disease and affected less by access to care or delay in diagnosis. Further studies are necessary to define factors predicting emergency surgery for diverticulitis

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