Socioeconomic and Other Predictors of Colonoscopy Preparation Quality

BackgroundSuboptimal 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.AimsThe aim of this study was to evaluate sociodemographic factors, including insurance status and marital status, as predictive of suboptimal preparation.MethodsWe 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.ResultsAmong 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).ConclusionsUnmarried 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.

[1]  C. Schoenborn.  Marital status and health: United States, 1999-2002. , 2004, Advance data.

[2]  N. Toribara,et al.  Colonoscopy completion in a large safety net health care system. , 2008, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[3]  L. Jandorf,et al.  A program to enhance completion of screening colonoscopy among urban minorities. , 2008, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[4]  A. Neugut,et al.  Duration of adjuvant chemotherapy for colon cancer and survival among the elderly. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[5]  J. Alexander,et al.  The Impact of Medicaid Status on Outcome After Gastric Bypass , 2008, Obesity surgery.

[6]  V. Sharma,et al.  Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. , 2003, Gastrointestinal endoscopy.

[7]  K. H. Park,et al.  Patient Factors Predictive of Inadequate Bowel Preparation Using Polyethylene Glycol: A Prospective Study in Korea , 2009, Journal of clinical gastroenterology.

[8]  N. Chalasani,et al.  Predictors of inadequate bowel preparation for colonoscopy , 2001, American Journal of Gastroenterology.

[9]  Judith R. Logan,et al.  Assessment of the quality of colonoscopy reports: results from a multicenter consortium. , 2009, Gastrointestinal endoscopy.

[10]  P. Maisonneuve,et al.  Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps. , 2008, Gastroenterology.

[11]  Douglas K. Rex,et al.  Impact of bowel preparation on efficiency and cost of colonoscopy , 2002 .

[12]  T. Kaiser,et al.  Access to Liver Transplantation in the MELD Era: Role of Ethnicity and Insurance , 2009, Digestive Diseases and Sciences.

[13]  Heitham Abdul-Baki,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. , 2005, Gastrointestinal endoscopy.

[14]  C. Gyawali,et al.  Impact of obesity on bowel preparation for colonoscopy. , 2009, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[15]  M. Kimmey,et al.  Incidence of minor complications and time lost from normal activities after screening or surveillance colonoscopy. , 2007, Gastrointestinal endoscopy.

[16]  A. Rostom,et al.  Validation of a new scale for the assessment of bowel preparation quality. , 2004, Gastrointestinal endoscopy.

[17]  S. Vanner,et al.  Pico-Salax Plus Two-Day Bisacodyl Is Superior to Pico-Salax Alone or Oral Sodium Phosphate for Colon Cleansing Before Colonoscopy , 2009, The American Journal of Gastroenterology.

[18]  Bernard Burnand,et al.  Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. , 2005, Gastrointestinal endoscopy.

[19]  B. Levin,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. , 2008, Gastroenterology.

[20]  S. Spechler,et al.  Duration of the interval between the completion of bowel preparation and the start of colonoscopy predicts bowel-preparation quality. , 2009, Gastrointestinal endoscopy.

[21]  A. Jemal,et al.  Cancer Statistics, 2008 , 2008, CA: a cancer journal for clinicians.

[22]  Gheorghe Doros,et al.  The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. , 2007, Gastrointestinal endoscopy.

[23]  A. Neugut,et al.  Racial and ethnic disparities in the prevalence of Barrett's esophagus among patients who undergo upper endoscopy. , 2008, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.