Differences in Gastroenterology Procedure Rates in Colombia According to Geographic Location and Health Insurance Regimen

Abstract

Introduction: Previous evidence suggests the existence of barriers that may result in differential access to healthcare in Colombia; however, the impact on diagnostic gastroenterology procedures has not been evaluated. Objectives: To assess procedure rates (PR) in gastroenterology and describe differences according to geographic location, insurance regimen, age, and sex. Methods: Secondary analysis of a population-based database containing data reported to the Integrated Social Protection Information System (SISPRO) in Colombia between 2017 and 2023. PRs were calculated for esophagogastroduodenoscopy (EGD), colonoscopy, endoscopic ultrasound (EUS), and endoscopic retrograde cholangiopancreatography (ERCP). Procedure rate ratios (PRRs) were computed according to geographic region, sex, and insurance regimen. Results: National PRs ranged from 66 per 100,000 inhabitants for EUS to 4,144 per 100,000 for EGD, with significantly lower rates in the Caribbean coast, southern, and eastern regions of Colombia. PRs were higher in women (PRR EGD: 1.66; confidence interval [CI]: 1.65–1.66; p < 0.001; PRR ERCP: 1.52; CI: 1.45–1.59; p < 0.001) and lower in patients under the subsidized insurance regimen (PRR ERCP: 0.85; CI: 0.82–0.89; p < 0.0001; PRR EUS: 0.50; CI: 0.49–0.51; p < 0.0001). A progressive increase in procedure rates with age was observed. Conclusions: Our findings indicate that procedure rates increase with age and are higher in women. Furthermore, patients residing in certain geographic areas of Colombia and those enrolled in the subsidized insurance regimen face barriers to accessing gastroenterology procedures. These results underscore the need to implement public health policies aimed at reducing these disparities.