Far from black and white: Role of race, health literacy, and socioeconomic factors in the presentation of acute diverticulitis.
Far from black and white: Role of race, health literacy, and socioeconomic factors in the presentation of acute diverticulitis.
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DOI：
10.1016/j.surg.2021.05.049
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发表时间：
2021-12
期刊：
影响因子：
3.8
通讯作者：
Hawkins AT
中科院分区：
文献类型：
--
作者：
Hamdan S;Kripalani S;Geiger TM;Dennis BM;Ford MM;Zhao Z;Ye F;Hawkins AT
在急性憩室炎的治疗和预后方面存在种族差异，但其潜在因素尚不清楚。我们的目的是确定急性憩室炎住院患者在健康素养（HL）方面的种族不平等，并描述与更严重表现相关的因素。我们对2009年1月至2019年9月在四级转诊中心因急性憩室炎住院的947例黑人或白色患者进行了回顾性队列分析。HL是由经过验证的简短健康素养筛查确定的，社会经济地位是由区域剥夺指数（ADI）定义的，ADI是多个社区社会经济剥夺措施的复合物。主要结局是以全身炎症反应综合征（SIRS）标准为代表的疾病严重程度;次要结局包括ICU入院、住院时间（LOS）和侵入性干预。在所有研究参与者中，121人（12.8%）自我认同为黑人。总体而言，140例（14.8%）患者的HL不足，495例（52.3%）患者的ADI大于国家中位数。种族或ADI与HL之间无相关性。共有340例（35.9%）患者符合SIRS标准，88例（9.3%）接受了干预;中位LOS为3.5天。种族、HL和ADI与结局无显著相关性（P>0.05）。在急性憩室炎患者中，未观察到人种、HL或ADI的严重程度差异。这些发现表明，急性憩室炎的表现差异可能不是由这些社会因素驱动的。未来的研究应考虑急性憩室炎的临床特征，如获得和未充分利用医疗资源的作用。在这项种族差异的调查中，我们发现，没有种族差异的健康素养（HL）的观察和种族，HL，和邻里的社会经济地位没有被认为是与介绍的严重程度。这份报告的重要性在于它强调了可能有其他未被认识的临床因素导致急性憩室炎结局的差异。
Racial discrepancies in treatment and outcomes of acute diverticulitis have been observed, yet underlying factors are poorly understood. We aimed to identify racial inequalities in health literacy (HL) among patients hospitalized with acute diverticulitis and characterize factors associated with more severe presentation. We performed retrospective cohort analysis of 947 Black or White patients admitted with acute diverticulitis at a quaternary referral center from January 2009 through September 2019. HL was determined by the validated Brief Health Literacy Screening and socioeconomic status was defined by area deprivation index (ADI), a composite of multiple neighborhood socioeconomic deprivation measures. The primary outcome was severity of disease presentation represented by systemic inflammatory response syndrome (SIRS) criteria; secondary outcomes included ICU admission, length of stay (LOS), and invasive interventions. Among all study participants, 121 (12.8%) self-identified as Black. Overall, 140 (14.8%) patients had inadequate HL and 495 (52.3%) had ADI greater than the national median. There was no association between race or ADI and HL. A total of 340 (35.9%) patients met criteria for SIRS and 88 (9.3%) underwent an intervention; median LOS was 3.5 day. Race, HL, and ADI were not significantly associated with outcomes (P>0.05). Among patients with acute diverticulitis, no difference in severity of presentation by race, HL, or ADI was observed. These findings suggest that differences in presentation of acute diverticulitis may not be driven by these social factors. Future studies should include considerations of clinical characteristics of acute diverticulitis, such as the role of access and underuse of healthcare resources. In this investigation of racial disparities, we find that no racial differences in health literacy (HL) were observed and that race, HL, and neighborhood socioeconomic status were not recognized to be associated with presentation severity. The importance of this report is that it highlights that there may be additional, unrecognized clinical factors that contribute to disparities in acute diverticulitis outcomes.
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