RACIST MEDICINE
Black men more likely to die after surgery than White men, or women of either race
Unequal post-surgery death rate mainly applies to planned surgeries. Findings highlight the need for better understanding of the challenges facing Black men requiring surgery in the US
Black men have a higher death rate within 30 days of surgery compared with any other subgroup of race and sex, finds a study of adults in the United States published in The BMJ.
This inequality in death rate was mainly observed for elective, or planned, surgeries, where the death rate for Black men was 50% higher than that of White men.
The researchers say further research is needed to understand better the “factors contributing to this higher mortality rate among Black men after elective surgery.”
In previous studies, racial inequities in surgical care and outcomes, including a higher death rate following surgery for Black patients, have been well documented.
However, less is known of how surgical outcomes differ by the race and sex of patients undergoing both elective or non-elective (urgent or emergency) surgeries.
To fill in this knowledge gap, the researchers used nationwide Medicare data on 1,868,036 adults with an average age of 75 years who underwent one of eight surgeries —abdominal aortic aneurysm repair, appendectomy, cholecystectomy, colectomy, coronary artery bypass surgery, hip replacement, knee replacement, and lung resection—between 2016–2018.
They analysed data for differences in death rates between subgroups of race and sex, following elective or urgent surgeries
Of the adults included in this study, 40.7% were White men, 53.4% were White women, 2.2% were Black men, and 3.7% were Black women. Just over 70% of the surgeries were elective.
After accounting for other potentially influential factors such as age, disability, and a range of underlying chronic conditions, the researchers found that Black men had a higher death rate (3.05%) within 30 days of both urgent and elective surgery than White men (2.69%), White women (2.38%), and Black women (2.18%).
A similar pattern was found for elective surgery: Black men had a higher death rate (1.3%) than White men (0.85%), White women (0.82%), and Black women (0.79%).
This 0.45 percentage point difference between Black and White men “implies that mortality after elective procedures was 50% higher in Black men compared with White men", say the researchers.
And much of this difference persisted even when patients operated on by the same surgeon were compared, they note.
The researchers did not find a statistically significant difference between Black and White men following urgent surgery, with death rates of 6.69% and 7.03%, respectively.
They did, however, find that deaths after urgent surgery were lower for both White and Black women, than men of either race, at 6.12% and 5.29%, respectively.
This is an observational study, so cannot establish cause, and the researchers acknowledge that their results were limited to Black and White Medicare patients undergoing certain procedures, so may not apply to other groups or types of surgery.
However, results remained largely unchanged after further sensitivity analyses, suggesting that they are robust.
The researchers suggest that structural racism within society, such as higher rates of poverty among Black patients, which can lead to poorer underlying health and challenges accessing care, may, at least partially, explain their findings, and say better standardisation of care is needed to help mitigate some of these factors and reduce inequities in surgical outcomes.
“Further research is needed to understand better the preoperative, intraoperative, and postoperative factors contributing to this higher mortality rate among Black men after elective surgery, ” they conclude.
JOURNAL
The BMJ
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Inequities in surgical outcomes by race and sex in the United States: retrospective cohort study
ARTICLE PUBLICATION DATE
1-Mar-2023
Older Black men are likelier to die after surgery than others, particularly following elective procedures, new UCLA research suggests
Older Black men are likelier to die after surgery than others, particularly following elective procedures, new UCLA research suggests
Older Black men have a higher chance of dying within 30 days of surgery than do Black women and white men and women – with their odds of death 50% higher after elective surgery compared with white men.
The researchers suspect that the “especially high cumulative amounts of stress and allostatic load” that Black men face the U.S. may significantly contribute to declines in their physical health, they write.
“While a fair bit is known about such inequities, we find in our analyses that it's specifically Black men who are dying more, and they are dying more after elective surgeries, not urgent and emergent surgeries,” said study lead Dr. Dan Ly, assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. “Our findings point to possibilities such as poorer pre-optimization of co-morbidities prior to surgery, delays of care due to structural racism and physician bias, and worse stress and its associated physical burden on Black men in the United States.”
The study was published March 1 in the peer-reviewed journal The BMJ.
The researchers examined Medicare data from 2016 through 2018, which were the most recent data available when they began the research, for about 1.87 million Black and white beneficiaries ages 65 to 99 years. These people had undergone one of eight common surgeries: abdominal aortic repair, appendectomy, cholecystectomy, colectomy, coronary artery bypass, hip replacement, knee replacement, and lung resection. These procedures were performed both planned (elective) and unplanned (urgent or emergent).
They found that overall, Black men had a higher adjusted mortality rate even after accounting for other differences between patients. For Black men, the mortality rate was about 3.05% compared with 2.69% among white men, 2.38% among white women, and 2.18% among Black women. This trend largely persisted with elective surgeries, with a death rate of 1.30% among Black men, compared with white men at 0.85%, white women at 0.82%, and Black women at 0.79%. The disparity between Black and white men began as early as seven days after surgery and was still present 60 days after surgery.
Structural racism may partly explain the disparity, the researchers write. For instance, predominantly Black neighborhoods are often near hospitals lacking high-quality healthcare resources such as specialists, including surgeons with advanced training, as well as the latest diagnostic imaging studies and tests. This can lead to treatment delays resulting in more advanced disease or more difficult surgeries.
In addition, poorer pre-operative care for conditions such as diabetes and hypertension, and more exposure to toxic hazards that are frequently found near their neighborhoods that can increase disease severity, may also contribute to the disparity.
“These differences in neighborhood, home environment and community resources may make it more challenging for Black patients, on average, to recover at home and to make postoperative clinical visits,” they note. “Our finding that Black men experience a higher surgical mortality compared with other subgroups of race and sex is troubling, and is also seen with shorter life expectancy among Black men more generally.”
Study limitations include a focus on Black and white patients to the exclusion of other racial and ethnic groups; the observational nature of the study, which may have missed other contributory factors; and that the data are from the Medicare fee-for-service population, so the results may not apply to other populations.
Additional study authors are Dr. Mariah Blegen, Dr. Melinda Gibbons, Dr. Keith Norris, and Dr. Yusuke Tsugawa of UCLA
The study was funded by the National Institute on Minority Health and Health Disparities (R01 MD013913).
JOURNAL
The BMJ
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Inequities in surgical outcomes by race and sex in the United States: retrospective cohort study
ARTICLE PUBLICATION DATE
1-Mar-2023
No comments:
Post a Comment