Abstract
BackgroundAlthough numerous epidemiological studies on cholecystectomy have been conducted worldwide, only a few have considered the effect of socioeconomic inequalities on cholecystectomy outcomes. Specifically, few studies have focused on the low-income population (LIP).MethodsA nationwide prospective study based on the Taiwan National Health Insurance dataset was conducted during 2003–2012. The International Classification of ICD-9-CM procedure codes 51.2 and 51.21–51.24 were identified as the inclusion criteria for cholecystectomy. Temporal trends were analyzed using a joinpoint regression, and the hierarchical linear modeling (HLM) method was used as an analytical strategy to evaluate the group-level and individual-level factors. Interactions between age, gender and SES were also tested in HLM model.ResultsAnalyses were conducted on 225,558 patients. The incidence rates were 167.81 (95% CI: 159.78–175.83) per 100,000 individuals per year for the LIP and 123.24 (95% CI: 116.37–130.12) per 100,000 individuals per year for the general population (GP). After cholecystectomy, LIP patients showed higher rates of 30-day mortality, in-hospital complications, and readmission for complications, but a lower rate of routine discharge than GP patients. The hospital costs and length of stay for LIP patients were higher than those for GP patients. The multilevel analysis using HLM revealed that adverse socioeconomic status significantly negatively affects the outcomes of patients undergoing cholecystectomy. Additionally, male sex, advanced age, and high Charlson Comorbidity Index (CCI) scores were associated with higher rates of in-hospital complications and 30-day mortality. We also observed that the 30-day mortality rates for patients who underwent cholecystectomy in regional hospitals and district hospitals were significantly higher than those of patients receiving care in a medical center.ConclusionPatients with a disadvantaged finance status appeared to be more vulnerable to cholecystectomy surgery. This result suggested that further interventions in the health care system are necessary to reduce this disparity.
Highlights
Numerous epidemiological studies on cholecystectomy have been conducted worldwide, only a few have considered the effect of socioeconomic inequalities on cholecystectomy outcomes
Data definition To examine the effects of socioeconomic inequalities on cholecystectomy outcomes in Taiwan, we used the diagnostic codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
To analyze the procedure causes, acute cholecystitis (AC) with a calculus/stone was defined as patients with ICD-9-CM diagnosis codes 574.0, 574.3, and 574.6; AC without a calculus/ stone was defined as patients with the ICD-9-CM diagnosis code 575.0; calculus without AC referred to patients with ICD-9-CM diagnosis codes 574.1, 574.2, 574.4, 574.5, 574.7, 574.8, or 574.9; other disorders of the gallbladder or biliary tract were defined as patients with ICD-9-CM diagnosis codes or 576, excluding diagnosis code 575.0; and malignant neoplasms of digestive organs and the peritoneum included patients with ICD-9-CM diagnosis codes 150–159, excluding diagnosis codes 574, 575, and
Summary
Numerous epidemiological studies on cholecystectomy have been conducted worldwide, only a few have considered the effect of socioeconomic inequalities on cholecystectomy outcomes. Lu et al International Journal for Equity in Health (2018) 17:22 numerous epidemiological studies on cholecystectomy have been conducted worldwide, few studies have considered the effect of socioeconomic inequalities on cholecystectomy outcomes. In some Western countries, socioeconomic status (SES) has been reported to have a strong association with postoperative mortality in numerous studies [8,9,10]. Carbonell et al [14] performed a nationwide study of 93,758 patients and demonstrated that income, insurance status, and race did not play a role in morbidity or mortality for patients who underwent cholecystectomy; academic or teaching status at the hospital did not influence patient outcomes. We expected to be able to provide some valuable information to assist surgeons in decision-making and to make recommendations to health policy decision-makers with respect to the development of preventive strategies
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