P0391 - Does Race and Insurance Status Determine the Quality of Bowel Preparation for Screening Colonoscopy?

Jayati Anand, BS¹, Yuvaraj Singh, MD², Curuchi Anand, MD^3
1Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; ²University of Massachusetts, Worcester, MA; ³University of Massachusetts Chan Medical School, Westborough, MA

Introduction: The quality of bowel preparation is a critical factor in the accuracy of a colonoscopy and its ability to detect adenomas. Inadequate bowel preparation can lead to a higher rate of missed adenomas, longer procedure times, and more adverse events. Previous research has identified several factors influencing bowel preparation quality, including age, gender, co-morbidities, and socioeconomic status. Notably, African American ethnicity has been suggested as a risk factor for inadequate bowel preparation, even after controlling for education and income. This study investigated the impact of race and insurance status on bowel preparation quality.

Methods: A retrospective chart review was performed on 200 consecutive screening colonoscopies at a community hospital. Collected data included patient demographics, Boston Bowel Preparation Score(BBPS), and insurance status. BBPS of 0-6 were categorized as inadequate preparation, and scores of 7-9 were adequate. Further, we performed a propensity-matched multinomial regression analysis using insurance type to match age, gender, and ethnicity with BBPS as an outcome.

Results: Of the 200 colonoscopies included, 76.5% had adequate bowel preparation. Distribution of inadequate prep by a) Ethnicity comprised 18% Caucasians, 42% African Americans, 14% Latinx, and 50% Asians (p< 0.05). b) Insurance comprised 10% commercial insurance, 30% Medicare, and 61% Medicaid (p< 0.05). On subgroup analysis, when matched for ethnicity, all Asians and Latinx, 70% Caucasians, and 66% African Americans with inadequate bowel prep had non-commercial insurance (p< 0.05). On the propensity score model, the odds ratio (OR) of observing BBPS scores < 6 were consistently increased across all ethnicities with non-commercial insurance (Mean OR >17; p< 0.05)

Discussion: The results of this study underscore the importance of ethnicity and insurance in determining the quality of bowel preparation. Notably, individuals with non-commercial insurance demonstrated a higher incidence of inadequate bowel preparation than those with commercial insurance, a correlation that persisted even after matching patients for their ethnicity. The type of insurance, reflecting socioeconomic status, is a crucial determinant of bowel preparation quality based on our results. These findings highlight the need for targeted strategies to address patients at high risk of poor bowel preparation. Such strategies could reduce the occurrence of missed lesions and healthcare disparities in colon cancer screening.


Disclosures:


Jayati Anand, BS¹, Yuvaraj Singh, MD², Curuchi Anand, MD³. P0391 - Does Race and Insurance Status Determine the Quality of Bowel Preparation for Screening Colonoscopy?, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.