Clinical models in surgery have identified disparities in surgical care including race, income and insurance status individually as potential causes. We attempted to determine if socioeconomic status (SES) affects presentation, treatment and health care burden in medical/surgical care using diverticular disease as a model.Methods: The 2006 New York (NY) State Inpatient Database was used to query 10,481 cases of diverticular disease occurring in patients 60-85 years of age. SES was assessed by creating a composite score based on race, primary insurance payer, and median income bracket (by residence zip-code). Patients were grouped into SES thirds. Propensity scores were used to create a case controlled comparison of low (1/3) and middle/high (2/3) SES groups to eliminate differences in patient demographics in an attempt to identify possible etiologies of differences in outcome. Primary outcomes were differences in disease presentation, use of elective surgery, complication rates and mortality after surgery, and prolonged length of stay (LOS). Results: On univariate analysis, low SES-patients were less likely to be treated with surgery (10.4% vs. 16.9%, p<0.0001) in emergent/urgent cases (7.4% vs. 9.4%, p=0.001) and elective cases (58.3% vs. 64.8%, p=0.06). When surgery was performed, patients of lower SES had higher complication rates (23.8% vs. 17.4%, p=0.005), more often required blood transfusion (48.7% vs 34.2%, p<0.0001), ICU stay (48.5% vs. 38.0%, p=0.0002), higher hospital charges ($65K vs. $53K, p=0.003) higher overall in-hospital mortality (7.4% vs. 3.6%, p=0.002) and more prolonged LOS (15.2% vs. 8.4%; p<0.0001). In matched groups, these differences persisted including rates of surgical complications and operative mortality (p<0.05; Table 1). Conclusions: After controlling for patient and hospital characteristics using a matched cohort, SES impacts disease presentation, likelihood to receive surgical intervention and resource utilization in cases of diverticular disease. Future studies to identify the causes of disparities in surgical outcomes due to differences in SES should focus on access to prevention, disease severity and operative care.
Table 1 Surgical outcomes in propensity matched groups

Variable	Low SES (n=3,989)	High SES (n=3,989)	p value
Surgery - Urgent	10.1%	17.1%	<0.0001
Surgery - Elective	58.5%	65.6%	0.07
ICU Stay	49.3%	38.6%	0.0006
Blood transfusion	49.8%	36.7%	<0.0001
Hospital charges	\.1K	\.7K	0.04
Operative complications	24.4%	18.1%	0.01
Operative mortality	7.7%	3.7%	0.004