Association between Ethnicity and Adequacy of Colonoscopy Preparation

Abstract

Purpose: Many factors, ranging from sociologic to genetic, underlie differences in health outcomes between races. Several studies have demonstrated challenges in providing successful preventive care such as colorectal cancer screening. There are limited data regarding the impact of ethnicity on the quality of preparations. The objective of this analysis was to investigate factors that affect the quality of colon preparation for colonoscopy. Methods: We retrospectively selected 358 consecutive patients who underwent colonoscopy in a large urban hospital center. We abstracted demographic data, medication usage, indications for colonoscopy and quality of preparations from electronic medical records. The quality of preparations was graded as adequate vs. inadequate based on the endoscopy report (excellent, good and adequate were recoded adequate; inadequate, poor and unsatisfactory were inadequate). Logistic regression analyses were performed to test for associations between the outcome and primary explanatory variables of interest. Results: We had complete data on 149 Hispanic and 209 non-Hispanic men (n=155) and women (n=203). Preparation was deemed adequate in 237 (66%) patients. On univariate analysis, patients with adequate preparations were likely to be younger (mean±SD, 57±13 vs. 60±12 years; p=0.08), of Hispanic ethnicity (46% vs. 33%; p=0.01) and have a higher current level of physical activity (13% vs. 5% ambulatory, not in-patient; p<0.01). There were no significant differences by sex, medication usage or co-morbidities (including diabetes, stroke, dementia and constipation). Whether the indication was for screening or diagnostic colonoscopy also did not affect the quality of colon preparation. By logistic regression, Hispanic patients had a significantly increased odds ratio of adequate preparations in both univariate and multivariate analyses. Conclusion: Ethnicity may play a significant role in influencing the quality of colonoscopy preparations. Large-scale, prospective trials are needed to define differences in gastrointestinal motility, diet patterns and genetic predisposition that could explain this association.Table: [1125] Univariate and multivariate analysis for adequacy of colonoscopy preparations