Retrospective Cohort Study
Copyright ©The Author(s) 2019.
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-9HCPCS
Endoscopic ultrasoundNA76975, 43231, 43232, 43237, 43238, 43242, 43259
Endoscopic retrograde cholangiopancreatography51.10, 51.11, 51.84-51.87, 51.99, 52.13, 52.9374328-74330, 43260-43269, 43271, 43272
Surgery52.51, 52.6, 52.748150, 48152, 48153, 48154, 48155
Jaundice782.4NA
Cholangitis576.1NA
Pruritus698.9NA
Table 2 Characteristics of patients with pancreatic cancer by receipt of endoscopic retrograde cholangiopancreatography n (%)
TotalReceived ERCPNo ERCPP value
Total32510 (100.0)14704 (45.2)17806 (54.8)
Sex0.49
Male14147 (43.5)6368 (45.0)7779 (55.0)
Female18363 (56.5)8336 (45.4)10027 (54.6)
Age< 0.01
65-7514205 (43.7)6665 (46.9)7540 (53.1)
76+18305 (56.3)8039 (43.9)10266 (56.1)
Marital status< 0.01
Married15928 (49.0)7370 (46.3)8558 (53.7)
Not married16582 (51.0)7334 (44.2)9248 (55.8)
Race< 0.01
White27399 (84.3)12534 (45.8)14865 (54.3)
Black3349 (10.3)1418 (42.3)1931 (57.7)
Other1762 (5.4)752 (42.7)1010 (57.3)
Year of diagnosis< 0.01
2000-200310388 (32.0)4955 (47.7)5433 (52.3)
2004-200711134 (34.3)4949 (44.5)6185 (55.6)
2008-201110988 (33.8)4800 (43.7)6188 (56.3)
Residence0.06
Metropolitan27161 (83.6)12346 (45.5)14815 (54.6)
Non-metropolitan5346 (16.5)2356 (44.1)2990 (55.9)
SEER registry region< 0.01
Northeast7153 (22.0)3326 (46.5)3827 (53.5)
Southeast8128 (25.0)3688 (45.4)4440 (54.6)
Midwest4243 (13.1)1835 (43.3)2408 (56.8)
West Coast12986 (39.9)5855 (45.1)7131 (54.9)
Income (zip code)0.96
High income7948 (25.0)3591 (45.2)4357 (54.8)
Low income23841 (75.0)10780 (45.2)13061 (54.8)
Education (zip code)0.02
Low education10188 (32.0)4702 (46.2)5486 (53.9)
High education21638 (68.0)9687 (44.8)11951 (55.2)
SEER historic stage< 0.01
Localized3042 (9.4)1806 (59.4)1236 (40.6)
Regional9178 (28.2)5946 (64.8)3232 (35.2)
Distant16846 (51.8)5170 (30.7)11676 (69.3)
Unstaged3400 (10.5)1758 (51.7)1642 (48.3)
Region of pancreas< 0.01
Head16670 (71.2)10710 (64.3)5960 (35.8)
Body/Tail6744 (28.8)1080 (16.0)5664 (84.0)
Symptoms
Jaundice14189 (43.7)11076 (78.1)3113 (21.9)< 0.01
Cholangitis3970 (12.2)3471 (87.4)499 (12.6)< 0.01
Pruritus1832 (5.6)1297 (70.8)535 (29.2)< 0.01
Charlson Comorbidity score0.12
014423 (46.6)6616 (45.9)7807 (54.1)
19049 (29.3)4181 (46.2)4868 (53.8)
23964 (12.8)1760 (44.4)2204 (55.6)
3+3487 (11.3)1550 (44.5)1937 (55.6)
Therapeutic treatment
Chemotherapy13235 (40.7)6679 (50.5)6556 (49.5)< 0.01
Radiation7298 (22.5)4198 (57.5)3100 (42.5)< 0.01
Surgery3259 (10.0)2368 (72.7)891 (27.3)< 0.01
Table 3 Use of endoscopic retrograde cholangiopancreatography over time using Cochran Armitage trend n (%)
TotalERCPP value
Year of diagnosis< 0.01
2000-2003103884955 (47.73)
2004-2007111344949 (44.45)
2008-2011109884800 (43.68)
Total3251014704 (45.2)
Table 4 Multivariable analysis of use of endoscopic retrograde cholangiopancreatography
Adjusted OR of receiving ERCP (95%CI)
Sex
Male1.00 (REF)
Female1.03 (0.96-1.11)
Age
65-751.00 (REF)
76+0.88 (0.82-0.95)
Marital status
Married1.00 (REF)
Not married0.90 (0.85-0.97)
Race
White1.00 (REF)
Black0.92 (0.82-1.04)
Other0.83 (0.70-0.97)
Education (zip code)
> 50% high school only1.14 (1.04-1.24)
> 50% some college1.00 (REF)
Income (zip code)
< 75th percentile1.10 (1.00-1.20)
> 75th percentile1.00 (REF)
Year of diagnosis
2000-20031.00 (REF)
2004-20070.85 (0.78-0.92)
2008-20110.76 (0.70-0.83)
Metropolitan area
Metropolitan area1.00 (REF)
Non-metropolitan area0.87 (0.79-0.97)
United States region
Southeast1.00 (REF)
Northeast1.07 (0.96-1.20)
Midwest0.96 (0.86-1.09)
West Coast1.03 (0.93-1.13)
Comorbid conditions
Charlson score 01.00 (REF)
Charlson score 11.06 (0.98-1.15)
Charlson score 20.96 (0.86-1.07)
Charlson score 3+0.99 (0.88-1.11)
Cancer site
Body or tail1.00 (REF)
Head of the Pancreas3.27 (2.99-3.57)
Symptoms1
Jaundice7.59 (7.06-8.17)
Cholangitis4.22 (3.71-4.81)
Pruritus1.42 (1.22-1.66)
SEER historic stage
Localized1.00 (REF)
Regional1.01 (0.89-1.14)
Distant0.52 (0.46-0.58)
Unstaged0.85 (0.73-1.00)
Cancer directed therapies1
Chemotherapy1.39 (1.28-1.51)
Radiation1.21 (1.11-1.33)
Surgery0.82 (0.73-0.92)
Table 5 Analysis stratified by symptoms/conditions
Adjusted OR of receiving ERCP (95%CI), amongst patients with JaundiceAdjusted OR of receiving ERCP (95%CI), amongst patients with CholangitisAdjusted OR of receiving ERCP (95%CI), amongst patients with Pruritus
Sex
Male1.00 (REF)1.00 (REF)1.00 (REF)
Female1.17 (1.05-1.30)0.99 (0.77-1.27)1.00 (0.75-1.33)
Age
65-751.00 (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
Married1.00 (REF)1.00 (REF)1.00 (REF)
Not married0.85 (0.76-0.94)0.97 (0.75-1.26)0.94 (0.70-1.26)
Race
White1.00 (REF)1.00 (REF)1.00 (REF)
Black0.80 (0.67-0.95)0.87 (0.58-1.28)0.88 (0.52-1.51)
Other0.73 (0.58-0.91)0.64 (0.42-0.98)1.00 (0.59-1.70)
Education (zip code)
> 50% high school only1.00 (0.88-1.13)0.79 (0.59-1.06)1.23 (0.88-1.71)
> 50% some college1.00 (REF)1.00 (REF)1.00 (REF)
Income (zip code)
< 75th percentile1.13 (0.99-1.30)1.50 (1.12-2.01)0.84 (0.60-1.17)
> 75th percentile1.00 (REF)1.00 (REF)1.00 (REF)
Year of diagnosis
2000-20031.00 (REF)1.00 (REF)1.00 (REF)
2004-20070.97 (0.86-1.10)0.94 (0.70-1.26)0.96 (0.67-1.39)
2008-20111.00 (0.88-1.13)1.02 (0.76-1.37)0.76 (0.54-1.06)
Metropolitan area
Metropolitan area1.00 (REF)1.00 (REF)1.00 (REF)
Non-metropolitan area0.79 (0.68-0.91)1.30 (0.87 -1.95)0.83 (0.56-1.24)
United States region
Southeast1.00 (REF)1.00 (REF)1.00 (REF)
Northeast0.94 (0.80-1.11)1.23 (0.83-1.83)0.73 (0.46-1.14)
Midwest0.91 (0.76-1.07)1.09 (0.71-1.69)1.01 (0.61-1.67)
West Coast0.95 (0.82-1.09)1.02 (0.72-1.43)0.75 (0.51-1.11)
Comorbid conditions
Charlson score 01.00 (REF)1.00 (REF)1.00 (REF)
Charlson score 11.06 (0.94-1.20)1.24 (0.92-1.67)1.24 (0.90-1.70)
Charlson score 20.93 (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 tail1.00 (REF)1.00 (REF)1.00 (REF)
Head of the pancreas3.82 (3.23-4.50)2.92 (1.98-4.31)8.03 (5.57-11.56)
SEER historic stage
Localized1.00 (REF)1.00 (REF)1.00 (REF)
Regional0.85 (0.71-1.01)0.79 (0.52-1.21)1.21 (0.80-1.82)
Distant0.51 (0.43-0.60)0.44 (0.29-0.66)0.83 (0.54-1.28)
Unstaged0.75 (0.60-0.94)0.46 (0.28-0.77)0.88 (0.47-1.65)
Cancer directed therapies1
Chemotherapy1.68 (1.48-1.90)1.578 (1.20-2.07)0.91 (0.66-1.26)
Radiation1.21 (1.06-1.39)1.25 (0.94-1.67)1.19 (0.86-1.64)
Surgery0.60 (0.52-0.69)0.48 (0.35-0.67)0.84 (0.5-1.20)