Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors.
Adil H. Haider,Valerie K. Scott,Karim Abdur Rehman,Catherine G. Velopulos,Jessica M. Bentley,Edward E. Cornwell,Waddah B. Al-Refaie +6 more
TLDR
A comprehensive review of the currently published surgical disparity literature in the United States found that patient factors such as insurance status and socioeconomic status need to be further explored, as studies indicated only a premature understanding of the relationship between racial disparities and SES.Abstract:
It is well known that there are significant racial disparities in health care outcomes, including surgery. However, the mechanisms that lead to these disparities are still not fully understood. In this comprehensive review of the currently published surgical disparity literature in the United States, we assess racial disparities in outcomes after surgical procedures, focusing on patient, provider, and systemic factors. The PubMed, EMBASE, and Cochrane Library electronic databases were searched with the keywords: healthcare disparities AND surgery AND outcome AND US. Only primary research articles published between April 1990 and December 2011 were included in the study. Studies analyzing surgical patients of all ages and assessing the endpoints of mortality, morbidity, or the likelihood of receiving surgical therapy were included. A total of 88 articles met the inclusion criteria. This evidence-based review was compiled in a systematic manner, relying on retrospective, cross-sectional, case-control, and prospective studies in the absence of Class I studies. The review found that patient factors such as insurance status and socioeconomic status (SES) need to be further explored, as studies indicated only a premature understanding of the relationship between racial disparities and SES. Provider factors such as differences in surgery rates and treatment by low volume or low quality surgeons also appear to play a role in minority outcome disparities. Finally, systemic factors such as access to care, hospital volume, and hospital patient population have been shown to contribute to disparities, with research consistently demonstrating that equal access to care mitigates outcome disparities.read more
Citations
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Racial and Ethnic Disparities in the Quality of Health Care
Kevin Fiscella,Mechelle Sanders +1 more
TL;DR: To eliminate racial and ethnic disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities.
Journal ArticleDOI
Gynecologic cancer disparities: A report from the Health Disparities Taskforce of the Society of Gynecologic Oncology
TL;DR: Gynecologic cancer disparities exist between Black and White women and much of the evidence suggests that equal care leads to equal outcomes for Black women diagnosed with gynecologic cancers.
Journal ArticleDOI
Unconscious race and social class bias among acute care surgical clinicians and clinical treatment decisions.
Adil H. Haider,Adil H. Haider,Eric B. Schneider,N. Sriram,Deborah S. Dossick,Deborah S. Dossick,Valerie K. Scott,Sandra M. Swoboda,Lia I. Losonczy,Elliott R. Haut,David T. Efron,Peter J. Pronovost,Pamela A. Lipsett,Edward E. Cornwell,Ellen J. MacKenzie,Lisa A. Cooper,Julie A. Freischlag +16 more
TL;DR: Unconscious social class and race biases were not significantly associated with clinical decision making among acute care surgical clinicians and in univariate analyses, a association between race/social class bias and 3 of 27 possible patient-care decisions was found.
Journal ArticleDOI
Setting a National Agenda for Surgical Disparities Research: Recommendations From the National Institutes of Health and American College of Surgeons Summit
Adil H. Haider,Adil H. Haider,Irene Dankwa-Mullan,Allysha C. Maragh-Bass,Allysha C. Maragh-Bass,Maya Torain,Maya Torain,Cheryl K. Zogg,Cheryl K. Zogg,Elizabeth J. Lilley,Elizabeth J. Lilley,Lisa M. Kodadek,Navin R. Changoor,Navin R. Changoor,Peter A. Najjar,Peter A. Najjar,John A. Rose,John A. Rose,Henri R. Ford,Ali Salim,Ali Salim,Steven C. Stain,Shahid Shafi,Beth Sutton,David B. Hoyt,Yvonne T. Maddox,L.D. Britt +26 more
TL;DR: Overall priorities, regardless of theme, included improving patient-clinician communication, fostering engagement and community outreach by using technology, improving care at facilities with a higher proportion of minority patients, evaluating the longer-term effect of acute intervention and rehabilitation support, and improving patient centeredness by identifying expectations for recovery.
Journal ArticleDOI
Unconscious race and class bias: its association with decision making by trauma and acute care surgeons.
Adil H. Haider,Eric B. Schneider,N. Sriram,Deborah S. Dossick,Valerie K. Scott,Sandra M. Swoboda,Lia I. Losonczy,Elliott R. Haut,David T. Efron,Peter J. Pronovost,Julie A. Freischlag,Pamela A. Lipsett,Edward E. Cornwell,Ellen J. MacKenzie,Lisa A. Cooper +14 more
TL;DR: Unconscious preferences for white and upper-class persons are prevalent among trauma and acute care surgeons, but these biases were not statistically significantly associated with clinical decision making.
References
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Journal ArticleDOI
Ethnic/racial disparities in hospital procedure volume for lung resection for lung cancer.
Charles J. Neighbors,Michelle L. Rogers,Edmond D. Shenassa,Christopher N. Sciamanna,Melissa A. Clark,Melissa A. Clark,Scott P. Novak +6 more
TL;DR: Ethnic/racial minorities are obtaining lung resection in lower volume hospitals and are more likely to die in hospital, but health insurance, segregation, and number of surgical hospitals within a county do not account for observed disparities.
Journal ArticleDOI
Disparities in the treatment and outcomes of vascular disease in Hispanic patients
Nicholas J. Morrissey,Jeannine K. Giacovelli,Jeannine K. Giacovelli,Natalia Egorova,Annetine C. Gelijns,Alan J. Moskowitz,James F. McKinsey,Kenneth Craig Kent,Giampaolo Greco +8 more
TL;DR: Significant disparities in the rate of utilization of three common vascular surgical procedures exist between Hispanic patients and the general population, and Hispanics appear to present with more advanced disease and have worse outcomes in some cases.
Journal Article
Total hip and total knee arthroplasties: trends and disparities revisited
Heejung Bang,Ya Lin Chiu,Stavros G. Memtsoudis,Lisa A. Mandl,Alejandro Gonzalez Della Valle,Alvin I. Mushlin,Robert G. Marx,Madhu Mazumdar +7 more
TL;DR: A large national database, Nationwide Inpatient Sample, 1996-2005, was used to study trends and racial and economic disparities associated with total hip and total knee arthroplasties, revealing that racial disparities were not confined to the elderly or to low-income populations.
Journal ArticleDOI
Racial Disparities in Esophageal Cancer Treatment and Outcomes
Alexander Greenstein,Virginia R. Litle,Scott J. Swanson,Celia M. Divino,Stuart Packer,Thomas McGinn,Juan P. Wisnivesky +6 more
TL;DR: Data suggest that blacks are at greater risk of death from esophageal cancer, while the disparity is due in part to differences in tumor histology, diagnosis at an earlier stage and higher rates of surgery among blacks could reduce this survival disparity.
Journal ArticleDOI
Explaining racial variation in lower extremity amputation: a 5-year retrospective claims data and medical record review at an urban teaching hospital.
TL;DR: The racial disparity at the study institution was primarily due to African American patients undergoing repeat major amputation at a significantly higher rate than whites.