Explaining racial disparities in surgical survival: a tapered match analysis of patient and hospital factors

ObjectivesEvaluate whether hospital factors, including nurse resources, explain racial differences in Medicare black and white patient surgical outcomes and whether disparities changed over time.DesignRetrospective tapered-match.Setting571 hospitals at two time points (Early Era 2003–2005; Recent Er...

Full description

Saved in:
Bibliographic Details
Published in:BMJ open Vol. 13; no. 5; p. e066813
Main Authors: Lasater, Karen B, Rosenbaum, Paul R, Aiken, Linda H, Brooks-Carthon, J Margo, Kelz, Rachel R, Reiter, Joseph G, Silber, Jeffrey H, McHugh, Matthew D
Format: Journal Article
Language:English
Published: England British Medical Journal Publishing Group 11.05.2023
BMJ Publishing Group LTD
BMJ Publishing Group
Series:Original research
Subjects:
Aged
Beneficiaries
Black or African American
Clinical outcomes
Demographics
Health maintenance organizations
HEALTH SERVICES ADMINISTRATION & MANAGEMENT
Healthcare Disparities
HMOs
Hospitals
Humans
Inequality
Medicaid
Medicare
Mortality
Nurses
Nursing
Organisation of health services
Patients
Race
Racial differences
Retrospective Studies
Surgery
Surgical outcomes
United States - epidemiology
Variables
White
Work environment
Workforce planning
United States
United States > US
New Jersey
Pennsylvania
HEALTH SERVICES ADMINISTRATION & MANAGEMENT
SURGERY
Organisation of health services
ISSN:2044-6055, 2044-6055
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:ObjectivesEvaluate whether hospital factors, including nurse resources, explain racial differences in Medicare black and white patient surgical outcomes and whether disparities changed over time.DesignRetrospective tapered-match.Setting571 hospitals at two time points (Early Era 2003–2005; Recent Era 2013–2015).Participants6752 black patients and three sets of 6752 white controls selected from 107 001 potential controls (Early Era). 4964 black patients and three sets of 4964 white controls selected from 74 108 potential controls (Recent Era).InterventionsBlack patients were matched to white controls on demographics (age, sex, state and year of procedure), procedure (demographics variables plus 136 International Classification of Diseases (ICD)-9 principal procedure codes) and presentation (demographics and procedure variables plus 34 comorbidities, a mortality risk score, a propensity score for being black, emergency admission, transfer status, predicted procedure time).Outcomes30-day and 1-year mortality.ResultsBefore matching, black patients had more comorbidities, higher risk of mortality despite being younger and underwent procedures at different percentages than white patients. Whites in the demographics match had lower mortality at 30 days (5.6% vs 6.7% Early Era; 5.4% vs 5.7% Recent Era) and 1-year (15.5% vs 21.5% Early Era; 12.3% vs 15.9% Recent Era). Black–white 1-year mortality differences were equivalent after matching patients with respect to presentation, procedure and demographic factors. Black–white 30-day mortality differences were equivalent after matching on procedure and demographic factors. Racial disparities in outcomes remained unchanged between the two time periods spanning 10 years. All patients in hospitals with better nurse resources had lower odds of 30-day (OR 0.60, 95% CI 0.46 to 0.78, p<0.010) and 1-year mortality (OR 0.77, 95% CI 0.65 to 0.92, p<0.010) even after accounting for other hospital factors.ConclusionsSurvival disparities among black and white patients are largely explained by differences in demographic, procedure and presentation factors. Better nurse resources (eg, staffing, work environment) were associated with lower mortality for all patients.
Bibliography:Original research
ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 14
content type line 23
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2022-066813