November 22, 2011 — Elderly black patients are 26% more likely to undergo urgent or emergency diverticulitis surgery than their white counterparts, and the difference can be traced to more than just insurance status and medical comorbidity, according to a study published in the November issue of the Archives of Surgery.
In addition, black patients were 28% more likely to be readmitted within 30 days following surgery, and they experienced a 28% higher in-hospital mortality rate compared with white Medicare patients.
Racial disparities have been observed previously in diverticulitis surgery, but are often thought to be consequences of differences in health insurance status and differences in medical comorbidities. To better understand the reasons for the racial disparities, Eric B. Schneider, PhD, from Johns Hopkins School of Medicine, Baltimore, Maryland, and colleagues compared the rates of elective vs urgent/emergency diverticulitis surgery in patients insured by Medicare.
The investigators analyzed data from the Medicare Provider Analysis and Review inpatient file. Their retrospective analysis included all black patients and white patients who were at least 65 years old, who received surgical treatment for primary diverticulitis, and who had complete admission and outcome data.
The study included 49,937 white patients and 2283 black patients. Black participants were younger on average (74.7 years vs 75.5 years; P < .001) and were more often women (75.2% vs 69.8%; P < .001). They also had more comorbidities (mean Charlson Comorbidity Index score, 0.98 vs 0.87; P < .001) and were more likely to undergo urgent/emergency surgery than elective surgery (67.8% vs 54.7%; P < .001).
The researches accounted for comorbidities, including history of myocardial infarction, heart disease, vascular disease, diabetes, renal disorder, liver disease, and cancer. For each patient, the researchers generated a weighted Charlson Comorbidity Index score and used it to adjust for overall comorbidity.
After adjustment for age, sex, and medical comorbidity, the researchers found that black patients were at a 26% increased risk for urgent/emergency admission (relative risk, 1.26; 95% confidence interval, 1.22 - 1.30). In addition, black patients were 28% more likely to die in the hospital than white patients (relative risk, 1.28; 95% confidence interval, 1.10 - 1.51).
Limitations of the study included its reliance on administrative and billing data, which limited patients' clinical histories to concurrent diagnostic coding. The records did not include detailed clinical history, laboratory values, or information on physical disabilities. Blacks are also underrepresented in Medicare compared with whites, which could have confounded the results.
"The underlying mechanisms that lead to higher rates of emergency vs elective admission, greater risk of in-hospital mortality, and substantially greater hospital expenses for blacks need to be elucidated so that interventions can be developed to eliminate the premature mortality and greater costs experienced by blacks," the authors write.
The authors have disclosed no relevant financial relationships.
Arch Surg. 2011;11:1272-1276. Abstract
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