Original article
Clinical endoscopy
Patterns of endoscopy in the United States: analysis of data from the Centers for Medicare and Medicaid Services and the National Endoscopic Database

https://doi.org/10.1016/j.gie.2007.08.041Get rights and content

Background

Patterns of GI endoscopy are influenced by the underlying epidemiology of GI disease, as well as by policy and practice guidelines.

Objective

To compare practice patterns of GI endoscopy between two large national databases of the United States.

Design

Descriptive database analysis.

Setting

A 5% sample of the entire U.S. Medicare population (Centers for Medicare and Medicaid Services, CMS data files) and endoscopic data repository of U.S. gastroenterology practices (Clinical Outcomes Research Initiative, CORI database) from 1999 to 2003.

Patients

The study population included 1,121,215 Medicare and 635,573 CORI patients undergoing various types of GI endoscopy.

Interventions

EGD, colonoscopy, and flexible sigmoidoscopy.

Main Outcome Measurements

Patient demographics, endoscopic diagnoses, time trends of diagnoses.

Results

A colonoscopy was the most common endoscopic procedure performed (CMS 53%, CORI 58%), followed by an EGD (37%, 32%), and a flexible sigmoidoscopy (10%, 10%). In the CMS data, women accounted for 59% of the EGDs, 57% of the colonoscopies, and 56% of the flexible sigmoidoscopies, and in the CORI data, the corresponding numbers were 57%, 55%, and 54%, respectively. Compared with their distribution in the U.S. census population, nonwhite patients in both databases underwent relatively more EGDs and fewer colonoscopies. The most common upper-GI diagnosis was GERD, followed by GI bleeding, gastric ulcer, and duodenal ulcer. The most common lower-GI diagnosis was colorectal polyp. Over the period of 1999 to 2003, the rates of colorectal cancer diagnosed with colonoscopy declined.

Limitations

Only a limited amount of information about individual patients was retrievable from the electronic databases.

Conclusions

A colonoscopy is now the most common endoscopic procedure in the United States. Women undergo both upper and lower endoscopic procedures more often than men. Nonwhite patients are underrepresented in the use of colonoscopy relative to the prevalence of nonwhite persons in the U.S. population. Increased use of a colonoscopy for colon screening and surveillance has been associated with a decreased rate of cancer diagnosis.

Section snippets

Materials and methods

Two separate databases were used for the present analysis: the Medicare 5% Carrier Standard Analytic File and the national endoscopic database (Clinical Outcomes Research Initiative [CORI] database). The first database was obtained from the Centers for Medicare and Medicaid Services (CMS), which provides access to Medicare data for epidemiologic research. The Medicare 5% Carrier Standard Analytic File is a representative 5% sample of all final action claims for physician/supplier Part B

Results

The 5% sample of the CMS data from 1999 to 2003 contained 1,121,215 endoscopic procedures, of which 37.1% were EGDs, 52.7% were colonoscopies, and 10.2% were flexible sigmoidoscopies. By comparison, the CORI database contained 635,573 endoscopies, of which 32.2% were EGDs, 57.6% were colonoscopies, and 10.2% were flexible sigmoidoscopies. Between 1999 and 2003, there was a slight drop in the fraction of EGDs in both databases. In both databases alike, the fractions of flexible sigmoidoscopies

Discussion

The CORI and CMS databases were used to study the characteristics of patients undergoing an EGD, a colonoscopy, and a flexible sigmoidoscopy. The majority of patients in the CMS database were older than 65 years, whereas, in the CORI database, the majority of patients were younger than 65 years. For those aged 65 years and older, however, the two databases were characterized by almost identical age distributions. Apart from the age distribution, the two databases showed generally similar

Acknowledgments

We are indebted to Edward Rosen, BA, and Nora C. Mattek, MPH, for their help in retrieving the CMS and CORI data.

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