Racial Disparities In Access To High Quality Hospitals For Surgical Care

Abstract

Introduction: Black patients have worse outcomes relative to white patients after surgery. We sought to determine whether this disparity could be explained by a lack of access to high-quality hospitals. We compared the likelihood of admission to high-quality hospitals for whites and blacks undergoing one of five common surgical procedures. Methods: The national Medicare database (2007-2008) was used to identify all patients undergoing coronary artery bypass graft, aortic valve replacement, esophagectomy, or pancreatic resection. To assess hospital quality, we used a composite measure that took into account mortality, hospital volume, and other variables. High quality hospitals were those ranked in the top 20%. We then evaluated whether black patients were less likely to be admitted to high quality hospitals. Logistic regression was used to adjust for patient characteristics and area-level socioeconomic status. Results: White patients were more likely than black patients to have surgery at high quality hospitals for all four procedures: coronary artery bypass grafting (20% vs. 17%), aortic valve replacement (20% vs. 14%), esophagectomy (21% vs. 13%), and pancreatic resection (21% vs. 15%). After adjusting for patient factors, black patients had a significantly lower likelihood of going to high quality hospitals compared to whites: coronary artery bypass graft (OR, 0.80; 95% CI, 0.75-0.84), aortic valve replacement (OR, 0.60; 95% CI, 0.53-0.68), esophagectomy (OR, 0.62; 95% CI, 0.43-0.88), and pancreatic resection (OR, 0.71; 95% CI, 0.55-0.93). Part of this disparity in access to high quality hospitals could be explained by socioeconomic status. However, even after adjusting for this factor, there was still a significant disparity for 4 of the 5 operations. Conclusions: Blacks patients are less likely than white patients to receive surgery at high quality hospitals. These disparities persisted after accounting for area-level socioeconomic status and other patient characteristics. Future efforts to decrease racial disparities in surgical outcomes should focus on increasing disadvantaged populations' access to high quality hospitals.