Abstract
Background: Scientific evidence confirm that significant racial disparities exist in healthcare, including surgery outcomes. However, the causal pathway underlying disparities at preoperative physical condition of children is not well-understood.Objectives: This research aims to uncover the role of socioeconomic and environmental factors in racial disparities at the preoperative physical condition of children through multidimensional integration of several data sources at the patient and population level.Methods: After the data integration process an unsupervised k-means algorithm on neighborhood quality metrics was developed to split 29 zip-codes from Memphis, TN into good and poor-quality neighborhoods.Results: An unadjusted comparison of African Americans and white children showed that the prevalence of poor preoperative condition is significantly higher among African Americans compared to whites. No statistically significant difference in surgery outcome was present when adjusted by surgical severity and neighborhood quality.Conclusions: The socioenvironmental factors affect the preoperative clinical condition of children and their surgical outcomes.
Highlights
Surgical disparities became rapidly growing concerns both in health care and clinical services [1,2,3,4]
Le Bonheur Children’s Hospital (LBCH), Memphis, TN participates in the National Surgical Quality Improvement Project-Pediatric (NSQIP-Ped) [16], and a trained surgical case reviewer abstracts clinical data for a non-random sample of procedures corresponding to about 15% of all surgeries
Our cohort is of 2,638 surgical cases including 58.8% male with average age and standard deviation (SD) of 7.2 ± 5.9 and with the racial distribution of 55.4% African American, 26.5% White, 16.8% unknown/unreported, and 1.3% others
Summary
Surgical disparities became rapidly growing concerns both in health care and clinical services [1,2,3,4]. Different social determinants of health [5] and experiencing unequal treatments [6] systematically produce, and further enhance, the disparities in health conditions and clinical outcomes. The high prevalence of poverty in the United States is a critical public health challenge. In 2018, approximately 38.1 million Americans lived in poverty [7]. Among racial and ethnic groups, African Americans had the highest poverty rate, 27.4%, followed by Hispanics at 26.6% and whites at 9.9%. Forty five point eight percent of young black children (under age six) live in poverty, compared to 14.5% of white children” [8]. The causal pathway underlying disparities at preoperative physical condition of children is not well-understood
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