Digestive Diseases and Sciences

, Volume 55, Issue 7, pp 2014–2020 | Cite as

Socioeconomic and Other Predictors of Colonoscopy Preparation Quality

  • Benjamin Lebwohl
  • Timothy C. Wang
  • Alfred I. NeugutEmail author
Original Article



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.


Colonoscopy Colorectal neoplasms Healthcare disparities Marriage Patient compliance 



We thank Alla Babina and Richard Elkin for their technical assistance in the extraction of data from the endoscopic database for this analysis. Grant support: B. Lebwohl is supported by the National Cancer Institute (training grant T32-CA095929).

Conflicts of interest statement

The authors have no conflicts of interest to disclose.


  1. 1.
    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.CrossRefPubMedGoogle Scholar
  2. 2.
    Harewood GC, Sharma VK, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc. 2003;58:76–79.CrossRefPubMedGoogle Scholar
  3. 3.
    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.CrossRefPubMedGoogle Scholar
  4. 4.
    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.CrossRefGoogle Scholar
  5. 5.
    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.CrossRefPubMedGoogle Scholar
  6. 6.
    Ness RM, Manam R, Hoen H, Chalasani N. Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol. 2001;96:1797–1802.CrossRefPubMedGoogle Scholar
  7. 7.
    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.CrossRefPubMedGoogle Scholar
  8. 8.
    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.CrossRefPubMedGoogle Scholar
  9. 9.
    Aronchick CA, Lipshutz WH, Wright H, DuFrayne F, Bergman G. Validation of an instrument to assess colon cleansing. Am J Gastroenterol. 1999;94:2667.Google Scholar
  10. 10.
    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.CrossRefPubMedGoogle Scholar
  11. 11.
    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.CrossRefPubMedGoogle Scholar
  12. 12.
    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.CrossRefPubMedGoogle Scholar
  13. 13.
    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.CrossRefPubMedGoogle Scholar
  14. 14.
    Schoenborn CA. Marital status, health: United States, 1999–2002. Adv Data. 2004;15:1–32.Google Scholar
  15. 15.
    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.CrossRefPubMedGoogle Scholar
  16. 16.
    Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96.CrossRefPubMedGoogle Scholar
  17. 17.
    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.CrossRefPubMedGoogle Scholar
  18. 18.
    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.CrossRefPubMedGoogle Scholar
  19. 19.
    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.CrossRefPubMedGoogle Scholar
  20. 20.
    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.CrossRefPubMedGoogle Scholar
  21. 21.
    Rex DK, Petrini JL, Baron TH, et al. Quality indicators for colonoscopy. Gastrointest Endosc. 2006;63:S16–S28.CrossRefPubMedGoogle Scholar
  22. 22.
    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.CrossRefPubMedGoogle Scholar
  23. 23.
    Rostom A, Jolicoeur E. Validation of a new scale for the assessment of bowel preparation quality. Gastrointest Endosc. 2004;59:482–486.CrossRefPubMedGoogle Scholar
  24. 24.
    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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Benjamin Lebwohl
    • 1
  • Timothy C. Wang
    • 1
    • 3
  • Alfred I. Neugut
    • 2
    • 3
    • 4
    Email author
  1. 1.Division of Digestive and Liver DiseaseColumbia UniversityNew YorkUSA
  2. 2.Division of Medical Oncology, Department of MedicineColumbia UniversityNew YorkUSA
  3. 3.Herbert Irving Comprehensive Cancer Center, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA
  4. 4.Department of Epidemiology, Mailman School of Public HealthColumbia University Medical CenterNew YorkUSA

Personalised recommendations