Retrospective Cohort Study
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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 16, 2019; 11(2): 133-144
Published online Feb 16, 2019. doi: 10.4253/wjge.v11.i2.133
Table 1 International Classification of Disease, 9th Edition and Healthcare Common Procedure Coding System codes for claims data
ICD-9 HCPCS Endoscopic ultrasound NA 76975, 43231, 43232, 43237, 43238, 43242, 43259 Endoscopic retrograde cholangiopancreatography 51.10, 51.11, 51.84-51.87, 51.99, 52.13, 52.93 74328-74330, 43260-43269, 43271, 43272 Surgery 52.51, 52.6, 52.7 48150, 48152, 48153, 48154, 48155 Jaundice 782.4 NA Cholangitis 576.1 NA Pruritus 698.9 NA
Table 2 Characteristics of patients with pancreatic cancer by receipt of endoscopic retrograde cholangiopancreatography n (%)
Total Received ERCP No ERCP P valueTotal 32510 (100.0) 14704 (45.2) 17806 (54.8) Sex 0.49 Male 14147 (43.5) 6368 (45.0) 7779 (55.0) Female 18363 (56.5) 8336 (45.4) 10027 (54.6) Age < 0.01 65-75 14205 (43.7) 6665 (46.9) 7540 (53.1) 76+ 18305 (56.3) 8039 (43.9) 10266 (56.1) Marital status < 0.01 Married 15928 (49.0) 7370 (46.3) 8558 (53.7) Not married 16582 (51.0) 7334 (44.2) 9248 (55.8) Race < 0.01 White 27399 (84.3) 12534 (45.8) 14865 (54.3) Black 3349 (10.3) 1418 (42.3) 1931 (57.7) Other 1762 (5.4) 752 (42.7) 1010 (57.3) Year of diagnosis < 0.01 2000-2003 10388 (32.0) 4955 (47.7) 5433 (52.3) 2004-2007 11134 (34.3) 4949 (44.5) 6185 (55.6) 2008-2011 10988 (33.8) 4800 (43.7) 6188 (56.3) Residence 0.06 Metropolitan 27161 (83.6) 12346 (45.5) 14815 (54.6) Non-metropolitan 5346 (16.5) 2356 (44.1) 2990 (55.9) SEER registry region < 0.01 Northeast 7153 (22.0) 3326 (46.5) 3827 (53.5) Southeast 8128 (25.0) 3688 (45.4) 4440 (54.6) Midwest 4243 (13.1) 1835 (43.3) 2408 (56.8) West Coast 12986 (39.9) 5855 (45.1) 7131 (54.9) Income (zip code) 0.96 High income 7948 (25.0) 3591 (45.2) 4357 (54.8) Low income 23841 (75.0) 10780 (45.2) 13061 (54.8) Education (zip code) 0.02 Low education 10188 (32.0) 4702 (46.2) 5486 (53.9) High education 21638 (68.0) 9687 (44.8) 11951 (55.2) SEER historic stage < 0.01 Localized 3042 (9.4) 1806 (59.4) 1236 (40.6) Regional 9178 (28.2) 5946 (64.8) 3232 (35.2) Distant 16846 (51.8) 5170 (30.7) 11676 (69.3) Unstaged 3400 (10.5) 1758 (51.7) 1642 (48.3) Region of pancreas < 0.01 Head 16670 (71.2) 10710 (64.3) 5960 (35.8) Body/Tail 6744 (28.8) 1080 (16.0) 5664 (84.0) Symptoms Jaundice 14189 (43.7) 11076 (78.1) 3113 (21.9) < 0.01 Cholangitis 3970 (12.2) 3471 (87.4) 499 (12.6) < 0.01 Pruritus 1832 (5.6) 1297 (70.8) 535 (29.2) < 0.01 Charlson Comorbidity score 0.12 0 14423 (46.6) 6616 (45.9) 7807 (54.1) 1 9049 (29.3) 4181 (46.2) 4868 (53.8) 2 3964 (12.8) 1760 (44.4) 2204 (55.6) 3+ 3487 (11.3) 1550 (44.5) 1937 (55.6) Therapeutic treatment Chemotherapy 13235 (40.7) 6679 (50.5) 6556 (49.5) < 0.01 Radiation 7298 (22.5) 4198 (57.5) 3100 (42.5) < 0.01 Surgery 3259 (10.0) 2368 (72.7) 891 (27.3) < 0.01
Table 3 Use of endoscopic retrograde cholangiopancreatography over time using Cochran Armitage trend n (%)
Total ERCP P valueYear of diagnosis < 0.01 2000-2003 10388 4955 (47.73) 2004-2007 11134 4949 (44.45) 2008-2011 10988 4800 (43.68) Total 32510 14704 (45.2)
Table 4 Multivariable analysis of use of endoscopic retrograde cholangiopancreatography
Adjusted OR of receiving ERCP (95%CI) Sex Male 1.00 (REF) Female 1.03 (0.96-1.11) Age 65-75 1.00 (REF) 76+ 0.88 (0.82-0.95) Marital status Married 1.00 (REF) Not married 0.90 (0.85-0.97) Race White 1.00 (REF) Black 0.92 (0.82-1.04) Other 0.83 (0.70-0.97) Education (zip code) > 50% high school only 1.14 (1.04-1.24) > 50% some college 1.00 (REF) Income (zip code) < 75th percentile 1.10 (1.00-1.20) > 75th percentile 1.00 (REF) Year of diagnosis 2000-2003 1.00 (REF) 2004-2007 0.85 (0.78-0.92) 2008-2011 0.76 (0.70-0.83) Metropolitan area Metropolitan area 1.00 (REF) Non-metropolitan area 0.87 (0.79-0.97) United States region Southeast 1.00 (REF) Northeast 1.07 (0.96-1.20) Midwest 0.96 (0.86-1.09) West Coast 1.03 (0.93-1.13) Comorbid conditions Charlson score 0 1.00 (REF) Charlson score 1 1.06 (0.98-1.15) Charlson score 2 0.96 (0.86-1.07) Charlson score 3+ 0.99 (0.88-1.11) Cancer site Body or tail 1.00 (REF) Head of the Pancreas 3.27 (2.99-3.57) Symptoms1 Jaundice 7.59 (7.06-8.17) Cholangitis 4.22 (3.71-4.81) Pruritus 1.42 (1.22-1.66) SEER historic stage Localized 1.00 (REF) Regional 1.01 (0.89-1.14) Distant 0.52 (0.46-0.58) Unstaged 0.85 (0.73-1.00) Cancer directed therapies1 Chemotherapy 1.39 (1.28-1.51) Radiation 1.21 (1.11-1.33) Surgery 0.82 (0.73-0.92)
Table 5 Analysis stratified by symptoms/conditions
Adjusted OR of receiving ERCP (95%CI), amongst patients with Jaundice Adjusted OR of receiving ERCP (95%CI), amongst patients with Cholangitis Adjusted OR of receiving ERCP (95%CI), amongst patients with Pruritus Sex Male 1.00 (REF) 1.00 (REF) 1.00 (REF) Female 1.17 (1.05-1.30) 0.99 (0.77-1.27) 1.00 (0.75-1.33) Age 65-75 1.00 (REF) 1.00 (REF) 1.00 (REF) 76+ 0.98 (0.88-1.09) 0.86 (0.67-1.10) 0.97 (0.73-1.29) Marital status Married 1.00 (REF) 1.00 (REF) 1.00 (REF) Not married 0.85 (0.76-0.94) 0.97 (0.75-1.26) 0.94 (0.70-1.26) Race White 1.00 (REF) 1.00 (REF) 1.00 (REF) Black 0.80 (0.67-0.95) 0.87 (0.58-1.28) 0.88 (0.52-1.51) Other 0.73 (0.58-0.91) 0.64 (0.42-0.98) 1.00 (0.59-1.70) Education (zip code) > 50% high school only 1.00 (0.88-1.13) 0.79 (0.59-1.06) 1.23 (0.88-1.71) > 50% some college 1.00 (REF) 1.00 (REF) 1.00 (REF) Income (zip code) < 75th percentile 1.13 (0.99-1.30) 1.50 (1.12-2.01) 0.84 (0.60-1.17) > 75th percentile 1.00 (REF) 1.00 (REF) 1.00 (REF) Year of diagnosis 2000-2003 1.00 (REF) 1.00 (REF) 1.00 (REF) 2004-2007 0.97 (0.86-1.10) 0.94 (0.70-1.26) 0.96 (0.67-1.39) 2008-2011 1.00 (0.88-1.13) 1.02 (0.76-1.37) 0.76 (0.54-1.06) Metropolitan area Metropolitan area 1.00 (REF) 1.00 (REF) 1.00 (REF) Non-metropolitan area 0.79 (0.68-0.91) 1.30 (0.87 -1.95) 0.83 (0.56-1.24) United States region Southeast 1.00 (REF) 1.00 (REF) 1.00 (REF) Northeast 0.94 (0.80-1.11) 1.23 (0.83-1.83) 0.73 (0.46-1.14) Midwest 0.91 (0.76-1.07) 1.09 (0.71-1.69) 1.01 (0.61-1.67) West Coast 0.95 (0.82-1.09) 1.02 (0.72-1.43) 0.75 (0.51-1.11) Comorbid conditions Charlson score 0 1.00 (REF) 1.00 (REF) 1.00 (REF) Charlson score 1 1.06 (0.94-1.20) 1.24 (0.92-1.67) 1.24 (0.90-1.70) Charlson score 2 0.93 (0.80-1.09) 0.69 (0.50-0.96) 0.77 (0.52-1.16) Charlson score 3+ 0.98 (0.83-1.16) 0.84 (0.58-1.21) 1.14 (0.72-1.80) Cancer site Body or tail 1.00 (REF) 1.00 (REF) 1.00 (REF) Head of the pancreas 3.82 (3.23-4.50) 2.92 (1.98-4.31) 8.03 (5.57-11.56) SEER historic stage Localized 1.00 (REF) 1.00 (REF) 1.00 (REF) Regional 0.85 (0.71-1.01) 0.79 (0.52-1.21) 1.21 (0.80-1.82) Distant 0.51 (0.43-0.60) 0.44 (0.29-0.66) 0.83 (0.54-1.28) Unstaged 0.75 (0.60-0.94) 0.46 (0.28-0.77) 0.88 (0.47-1.65) Cancer directed therapies1 Chemotherapy 1.68 (1.48-1.90) 1.578 (1.20-2.07) 0.91 (0.66-1.26) Radiation 1.21 (1.06-1.39) 1.25 (0.94-1.67) 1.19 (0.86-1.64) Surgery 0.60 (0.52-0.69) 0.48 (0.35-0.67) 0.84 (0.5-1.20)