Disparities in Evaluation of Patients With Rectal Bleeding 40 Years and Older

• Published in: Clinical gastroenterology and hepatology Vol. 12; no. 4; pp. 669 - 675
• Main Authors: Shields, Helen M, Stoffel, Elena M, Chung, Daniel C, Sequist, Thomas D, Li, Justin W, Pelletier, Stephen R, Spencer, Justin, Silk, Jean M, Austin, Bonita L, Diguette, Susan, Furbish, Jean E, Lederman, Ruth, Weingart, Saul N
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2014
• Subjects: Adult; Age; Aged; Aged, 80 and over; Colonoscopy - utilization; Colorectal Cancer; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - pathology; Early Detection; Female; Gastroenterology and Hepatology; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - etiology; Health Services Accessibility - statistics & numerical data; Humans; Male; Middle Aged; Patient Acceptance of Health Care - statistics & numerical data; Patient Management; Retrospective Studies; Time Factors; Early Detection; Colorectal Cancer; Patient Management; Age
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2013.07.008

Background & Aims Rectal bleeding is associated with colorectal cancer. We characterized the evaluation of patients aged 40 years and older with rectal bleeding and identified characteristics associated with inadequate evaluation. Methods We conducted a retrospective review of records of outpatient visits that contained reports of rectal bleeding for patients aged 40 years and older (N = 480). We studied whether patient characteristics affected whether or not they received a colonoscopy examination within 90 days of presentation with rectal bleeding. Patient characteristics included demographics; family history of colon cancer and polyps; and histories of screening colonoscopies, physical examinations, referrals to specialists at the index visit, and communication of laboratory results. Data were collected from medical records, and patient income levels were estimated based on Zip codes. Results Nearly half of the patients presenting with rectal bleeding received colonoscopies (48.1%); 81.7% received the procedure within 90 days. A history of a colonoscopy examination was more likely to be reported in white patients compared with Hispanic or Asian patients ( P  = .012 and P  = .006, respectively), and in high-income compared with low-income patients ( P  = .022). A family history was more likely to be documented among patients with private insurance than those with Medicaid or Medicare ( P  = .004). A rectal examination was performed more often for patients who were white or Asian, male, and with high or middle incomes, compared with those who were black, Hispanic, female, or with low incomes ( P  = .027). White patients were more likely to have their laboratory results communicated to them than black patients ( P  = .001). Conclusions Sex, race, ethnicity, patient income, and insurance status were associated with disparities in evaluation of rectal bleeding. There is a need to standardize the evaluation of patients with rectal bleeding.