Inequities in rates of variceal screening examinations

Abstract

Abstract Background The role of esophagogastroduodenoscopy (EGD) in screening for varices in patients with cirrhosis is well established. However, it is unknown how insurance status impacts the rate of variceal screening. Therefore, we examined an at-risk population to determine the effect of insurance status on the rate of variceal screening. Results Data were available on 111 patients who had an EGD ordered for variceal screening over this 18-month period. Analysis showed that six of sixteen (37.5%) uninsured patients versus sixty-three of ninety-five (66.4%) insured patients underwent EGD for screening purposes. Comparing these rates revealed a significant difference (p < 0.05, 95% CI 0.0841, 1.034). There were no significant differences comparing gender or ethnicity among the two groups. The unadjusted odds ratio (OR) of completing screening dependent on insurance status was 3.28 (95% CI 1.09–9.84, p = 0.03). These findings suggest that lack of insurance negatively affects EGD completion rates among the cirrhotic patient population. Conclusions This analysis suggests that lack of insurance adversely impacts variceal screening rates among patients with cirrhosis. Recognition of this disparity is an important first step in finding methods to deliver appropriate care to these patients, reduce avoidable adverse outcomes and decrease the high cost of hospitalization associated with this pathology.

Keywords

• Esophagogastroduodenoscopy (EGD)
• Varices
• Cirrhosis
• Nonselective beta blocker therapy (NSBB)
• Transnasal endoscopy (TNE)