Published online Aug 16, 2022. doi: 10.4253/wjge.v14.i8.474
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
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.
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.
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.
Retrospective cohort study and data analysis of National Inpatient Sample, Healthcare Cost and Utilization Project, provided by the Agency for Healthcare Research and Quality.
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.
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.
Future research should be aimed at determining mortality differences in patients with lower gastrointestinal bleeds that receive colonoscopy between urban and rural hospitals.