Racial Disparities in Common Surgeries Persist in the United States

By Megan Brooks

January 19, 2021

NEW YORK (Reuters Health) - Despite national initiatives aimed at reducing racial disparities in healthcare, these disparities persist in patients undergoing major surgical procedures in the United States, a new study indicates.

"Our study showed that Black patients underwent major surgical procedures at lower rates than white patients regardless of insurance status, hospital teaching status, or geographic location in the U.S. For some procedures, we even found that racial disparities worsened over the study period from 2012 to 2017," Dr. Matthew Best of Massachusetts General Hospital and Harvard Medical School, in Boston, told Reuters Health by email.

To see if the U.S. federal action plan for reducing racial disparities in healthcare launched in 2011 is working, Dr. Best and his colleagues analyzed national inpatient data from 2012 to 2017.

They found that racial disparities persisted during the study period for all nine surgical procedures analyzed (angioplasty, spinal fusion, carotid endarterectomy, appendectomy, colorectal resection, coronary artery bypass grafting, total hip arthroplasty, total knee arthroplasty, and heart valve replacement) and worsened for three procedures (total hip and knee arthroplasty and heart valve replacement).

For example, the rate of total knee arthroplasty (per 100,000 persons) in 2012 was 184.8 for white men versus 79.8 for Black men.s In 2017, incidence rate of total-knee arthroplasty was 220.5 for white men but only 95.6 for Black men.

"In 2017, racial differences persisted in all U.S. census divisions and in both urban teaching and urban nonteaching hospitals," the study team said in JAMA Surgery.

"When rates were adjusted based on insurance status, Black patients with Medicare, Medicaid, and private insurance underwent lower rates of all procedures analyzed compared with white patients. For example, rate of spinal fusion in Black patients was 70.2% of the rate in white patients with Medicare, 56.5% to that of white patients with Medicaid, and 61.2% to that of white patients with private insurance," they note.

The researchers say one limitation of the study is the inability to determine whether these differences are due to overuse by white patients or underuse by Black patients. One strength of the study is that it provides a nationally representative, all-payer sample that can be used to analyze changes that cannot be examined with smaller patient cohorts.

"Although we could not determine the exact reasons for the racial disparities seen in this study, the findings are disappointing and show that current programs to reduce racial inequality among surgical patients may be falling short," Dr. Best told Reuters Health.

"Our study highlights an urgent need for new and improved initiatives, increased funding, enhanced collaboration among healthcare leaders and physicians, and better access to care in order to reduce racial disparities and improve healthcare equality for all races," Dr. Best said.

SOURCE: https://bit.ly/3bDoj38 JAMA Surgery, online January 13, 2021.