Black or African American patients were significantly less likely to undergo operative interventions for diverticulitis than their white counterparts, according to a study presented at the 2023 annual meeting of the Surgical Infection Society.
The presenting investigator Andrew Tran, MD, a research resident with the General Surgery Program at the National Medical Center, in Cleveland, emphasized the importance of recognizing these disparities and advocating for better health equity.
“Patients who underwent operative management for diverticulitis were less likely to be of Black or African American race, and this is true in both uncomplicated and complicated diverticulitis,” Dr. Tran said.
Variation in Treatment Can Lead to Bias
As Dr. Tran explained, diverticulitis is a disease with evolving practice management guidelines, and individualization of care has become paramount. However, this variation in treatment can lead to provider or systemic bias, potentially introducing disparities. Previous studies have shown that certain minority groups experience worse outcomes in diverticulitis management.
For this study, Dr. Tran’s team used the Trinetics Research Database to identify patients diagnosed with diverticulitis and categorized them into uncomplicated and complicated cases. A propensity-matched, case-control design was employed, with separate analyses for the two categories.
In the uncomplicated diverticulitis group, white patients made up a larger proportion of those who underwent operative management (79% vs. 74%). In contrast, Black or African American patients constituted a higher proportion of those receiving nonoperative management (14% vs. 9%). Similar patterns were observed in the complicated diverticulitis group.
Dr. Tran noted several study limitations, including reliance on diagnostic coding based on billing information and the inability to assess the true acuity of a patient at the time of presentation or intervention. Despite these limitations, the study’s findings suggest that racial disparities exist in diverticulitis management, he said.
“Health disparities are a complex issue, with factors such as access to care, quality of care, insurance coverage and utilization of the healthcare system contributing to the problem,” Dr. Tran said. “Moreover, mistrust among certain patient groups may influence their likelihood to consent to surgery.
“While the exact reasons for these disparities remain unclear, continued recognition and further research are crucial steps toward addressing the issue,” he added.
In future studies, Dr. Tran said, the team hopes to identify factors associated with decreased surgical interventions among minority groups, which in turn will enable the development of protocols to reduce these disparities.
Access to Care Issues
Abstract discussant Philip S. Barie, MD, a professor of surgery and public health at Weill Cornell Medical College, in New York City, said this study raises several important questions and provides insights into the complexities of health disparities in diverticulitis management.
Dr. Barie also offered suggestions on how researchers could move beyond simply quantifying disparities to understanding the underlying factors contributing to them.
“It might be worth exploring access to surgical care, particularly the availability of general surgeons, as a possible factor influencing disparities. You could also consider geographic correction in the analysis to account for variations in access to surgeons across different regions.”
Dr. Barie also raised concerns about patient mistrust and hesitancy, asking whether the study could determine how many patients may have disadvantaged themselves by refusing indicated therapy.
Study Definitions Questioned
According to Dr. Barie, the prevalence rate for operative management of uncomplicated diverticulitis in the study seemed high, given that the trend is moving toward nonoperative management. He questioned the accuracy of diagnosing and staging uncomplicated diverticulitis patients and whether the definitions used in the study were appropriate.
Finally, Dr. Barie considered the possibility of diagnostic disparities rather than therapeutic disparities, and questioned whether the observed disparity might represent a paradox.
“As the paradigm shifts toward nonoperative management of diverticulitis,” he said, “Black and Asian patients with a lower likelihood of surgery for uncomplicated cases might actually be receiving better care.”
—Chase Doyle
This article is from the October 2023 print issue.