Socioeconomic and Other Predictors of Colonoscopy Preparation Quality
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Suboptimal bowel preparation prior to colonoscopy is a common occurrence, with a deleterious impact on colonoscopy effectiveness. Established risk factors for suboptimal bowel preparation have been proposed, but social factors, such as socioeconomic status and marital status, have not been investigated.
The aim of this study was to evaluate sociodemographic factors, including insurance status and marital status, as predictive of suboptimal preparation.
We analyzed a database of 12,430 consecutive colonoscopies during a 28-month period at Columbia University Medical Center. We collected the following variables: age, gender, indication for colonoscopy, location (inpatient vs. outpatient), race, marital status, and Medicaid status. Preparation quality was recorded and dichotomized as optimal or suboptimal. We employed multivariate regression to determine independent risk factors for suboptimal bowel preparation.
Among the 10,921 examinations in which bowel preparation was recorded, suboptimal preparation occurred in 34% of Medicaid patients versus 18% of non-Medicaid patients (P < 0.0001); this remained significant in the multivariate analysis (odds ratio (OR) 1.84, 95% CI 1.61–2.11). Married patients had decreased rates of suboptimal preparation (OR 0.89, 95% CI 0.80–0.98). Other variables associated with suboptimal preparation included increased age (OR per 10 years 1.09, 95% CI 1.05–1.14), male gender (OR 1.44, 95% CI 1.31–1.59), inpatient status (OR 1.51, 95% CI 1.26–1.80), and later time of day (OR 1.89, 95% CI 1.71–2.09).
Unmarried status and Medicaid status are predictive of suboptimal bowel preparation. Future studies are warranted to identify how these social conditions predict bowel preparation quality and to implement interventions to optimize bowel preparation in vulnerable populations.
- Froehlich F, Wietlisbach V, Gonvers JJ, Burnand B, Vader JP. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European panel of appropriateness of gastrointestinal endoscopy European multicenter study. Gastrointest Endosc. 2005;61:378–384. CrossRef
- Harewood GC, Sharma VK, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc. 2003;58:76–79. CrossRef
- Rex DK, Imperiale TF, Latinovich DR, Bratcher LL. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol. 2002;97:1696–1700. CrossRef
- Chung YW, Han DS, Park KH, et al. Patient factors predictive of inadequate bowel preparation using polyethylene glycol: a prospective study in Korea. J Clin Gastroenterol. 2008;43:448–452. CrossRef
- Siddiqui AA, Yang K, Spechler SJ, et al. Duration of the interval between the completion of bowel preparation and the start of colonoscopy predicts bowel-preparation quality. Gastrointest Endosc. 2009;69:700–706. CrossRef
- Ness RM, Manam R, Hoen H, Chalasani N. Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol. 2001;96:1797–1802. CrossRef
- Kazarian ES, Carreira FS, Toribara NW, Denberg TD. Colonoscopy completion in a large safety net health care system. Clin Gastroenterol Hepatol. 2008;6:438–442. CrossRef
- Abrams JA, Fields S, Lightdale CJ, Neugut AI. Racial and ethnic disparities in the prevalence of Barrett’s esophagus among patients who undergo upper endoscopy. Clin Gastroenterol Hepatol. 2008;6:30–34. CrossRef
- Aronchick CA, Lipshutz WH, Wright H, DuFrayne F, Bergman G. Validation of an instrument to assess colon cleansing. Am J Gastroenterol. 1999;94:2667.
- Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58:130–160. CrossRef
- Borg BB, Gupta NK, Zuckerman GR, Banerjee B, Gyawali CP. The impact of obesity on bowel preparation for colonoscopy. Clin Gastroenterol Hepatol. 2009;7:670–675. CrossRef
- Hookey LC, Vanner SJ. Pico-salax plus two-day bisacodyl is superior to pico-salax alone or oral sodium phosphate for colon cleansing before colonoscopy. Am J Gastroenterol. 2009;104:703–7039. CrossRef
- Aoun E, Abdul-Baki H, Azar C, et al. A randomized single-blind trial of split-dose peg-electrolyte solution without dietary restriction compared with whole dose peg-electrolyte solution with dietary restriction for colonoscopy preparation. Gastrointest Endosc. 2005;62:213–218. CrossRef
- Schoenborn CA. Marital status, health: United States, 1999–2002. Adv Data. 2004;15:1–32.
- Neugut AI, Matasar M, Wang X, et al. Duration of adjuvant chemotherapy for colon cancer and survival among the elderly. J Clin Oncol. 2006;24:2368–2375. CrossRef
- Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96. CrossRef
- Kemmer N, Zacharias V, Kaiser TE, Neff GW. Access to liver transplantation in the meld era: role of ethnicity and insurance. Dig Dis Sci. 2008;54:1794–1797. CrossRef
- Alexander JW, Goodman HR, Martin Hawver LR, James L. The impact of medicaid status on outcome after gastric bypass. Obes Surg. 2008;18:1241–1245. CrossRef
- Ko CW, Riffle S, Shapiro JA, et al. Incidence of minor complications and time lost from normal activities after screening or surveillance colonoscopy. Gastrointest Endosc. 2007;65:648–656. CrossRef
- Chen LA, Santos S, Jandorf L, et al. A program to enhance completion of screening colonoscopy among urban minorities. Clin Gastroenterol Hepatol. 2008;6:443–450. CrossRef
- Rex DK, Petrini JL, Baron TH, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2006;63:S16–S28. CrossRef
- Lieberman DA, Faigel DO, Logan JR, et al. Assessment of the quality of colonoscopy reports: results from a multicenter consortium. Gastrointest Endosc. 2009;69:645–653. CrossRef
- Rostom A, Jolicoeur E. Validation of a new scale for the assessment of bowel preparation quality. Gastrointest Endosc. 2004;59:482–486. CrossRef
- Lai EJ, Calderwood AH, Doros G, Fix OK, Jacobson BC. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc. 2009;69:620–625. CrossRef
- Socioeconomic and Other Predictors of Colonoscopy Preparation Quality
Digestive Diseases and Sciences
Volume 55, Issue 7 , pp 2014-2020
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- Author Affiliations
- 1. Division of Digestive and Liver Disease, Columbia University, 630 West 168th Street, New York, NY, 10032, USA
- 3. Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, 1130 St. Nicholas Ave., Room 923, New York, NY, 10032, USA
- 2. Division of Medical Oncology, Department of Medicine, Columbia University, New York, NY, USA
- 4. Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, 722 West 168th St., Room 725, New York, NY, 10032, USA