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The segregation index as a predictor of access to specialized surgical care by minority populations in the United States
QUALITY, OUTCOMES, AND COSTS II was performed to examine the association between access to specialized surgical services and proportion of minority population with varying levels of segregation adjusting for socioeconomic and health characteristics within a county.
Racial disparities in the care of acute cholecystitis: A national study Anand Singla BA, Melissa M Murphy MD, Sing-Chau Ng MS, YouFu Li MD, Jennifer F Tseng MD, FACS, Shimul A Shah MD, FACS University of Massachusetts Medical School, Worcester, MA
RESULTS: In the most segregated counties, with the highest Segregation Index each percentage point increase in Hispanic or Black population was associated with a statistically significant decrease in inpatient surgery volume (p ⬍ 0.0001), specialized surgical facilities (p ⬍ 0.0001), number of cardiothoracic surgeons (p ⬍ 0.0001), number of colorectal surgeons (p ⬍ 0.0001), number of radiation oncologists (p ⬍ 0.0001), and number of gastroenterologists (p ⬍ 0.0001). In the least segregated counties, these associations showed no statistical significance.
INTRODUCTION: Racial differences in utilization and outcomes of major surgical procedures have been shown previously. We sought to investigate whether racial disparities exist in common diseases like acute cholecystitis (AC). METHODS: Discharge records (Nationwide Inpatient Sample) for all adult admissions (n ⫽ 205,119) with a primary diagnosis of AC from 1998 to 2006 were examined. A cohort of only white and black patients was created. Covariates included other patient demographics, comorbidities, and hospital characteristics. Separate logistic regression models were created to identify areas of disparity in clinical care.
CONCLUSIONS: In counties with the highest Segregation Index, an increase in the black or Hispanic population was associated with a decrease in the availability and utilization of specialized surgical services after adjustment for socioeconomic and health characteristics.
RESULTS: 86.0% of patients received a cholecystectomy; 89.9% were laparoscopic (LC). 22,308 (10.9%) were identified as black. Compared with white patients, black patients tended to be female (74.5% vs 58.7%), have Medicaid insurance (19.1% vs 6.2%), lower income (82.4% vs 66.8%), and have more than 1 comorbidity (69.3% vs 65.6%) (p ⬍ 0.0001). After adjusting for hospital and patient factors, black patients were less likely to receive a cholecystectomy (odds ratio [OR], 0.70). For those who did, blacks were less likely to receive LC (OR, 0.70) and underwent open conversion more often (OR, 1.23). Blacks were also more likely to experience a postoperative complication (OR, 1.17), have a prolonged LOS (OR, 1.73), and more likely to die during the hospital stay when compared with white patients (OR, 1.37; 95% confidence interval, 1.17 to 1.59).
Insurance status and geography but not race affect mortality in penetrating trauma victims Fuad Alkhoury MD, Steven Yood MD, MPH, Marianne Ulcickas Yood PhD, Jeremiah T Martin MD, Karen Wells BA, Scott Helton MD, Randall Zuckerman MD, FACS Hospital of Saint Raphael, New Haven, CT INTRODUCTION: A number of studies have demonstrated disparities between racial groups in trauma patients, with African American patients having worse outcomes. We examined the independent effect of insurance status and race on mortality following penetrating trauma, adjusting for the severity of injury, geography, and other demographic factors.
CONCLUSIONS: Our findings raise concerns about the delivery of care and outcomes for black compared with white patients with common surgical diseases like AC. Future studies should investigate possible social, biologic, and economic reasons for these disparities.
METHODS: Using data from the National Trauma Data Bank years 2001–2006, patients greater than 16 years of age with penetrating trauma were identified. A multiple logistic regression analysis was performed to determine differences in survival, adjusting for age, insurance status, hospital setting, ACS trauma designation, geographical region, and injury severity score (ISS).
The segregation index as a predictor of access to specialized surgical care by minority populations in the United States
RESULTS: A total of 139,950 patients were identified. 39% were African American, and 16% were Hispanic. After adjustment for covariates, African American patients did not have an increased risk of death (adjusted odds ratio (aOR) ⫽ 0.84; 95% confidence interval (CI), 0.80–0.89), nor did Hispanic patients (aOR⫽ 0.75; 95% CI, 0.70–0.80). Uninsured patients were 2 times more likely to die when compared with insured patients (aOR ⫽ 2.13; 95% CI, 1.94–2.35). Patients from the Northeast were 52% more likely to survive (aOR ⫽ 0.48; 95% CI, 0.42–0.54) as compared with other regions.
Awori J Hayanga MD, MPH, Heather Kaiser MPH, David Chang MBA, PhD, Martin A Makary MD, MPH, FACS University of Michigan, Ann Arbor, MI INTRODUCTION: Minority groups in the United States (US) have comparatively poorer access to a range of health care services. Access remains a function of opportunity and utilization and may be influenced by the level of segregation within a county. We hypothesized that varying levels of segregation, as determined by the Segregation Index, may determine access to specialized surgical care.
CONCLUSIONS: In this study using a nationwide database, lack of health insurance independently predicted mortality after penetrating trauma. Race was not an independent predictor of mortality after penetrating trauma. Residing in the Northeast had a protective effect. Reason for this is unknown and requires further analysis and study.
METHODS: A cross-sectional analysis was performed on data from the 2004 Area Resource File (ARF). Each county in the US was categorized into 1 of 3 levels: most, moderately, or least segregated using the Segregation Index. Multivariable linear regression analysis
© 2009 by the American College of Surgeons Published by Elsevier Inc.
ISSN 1072-7515/09/$34.00
S98
Racial disparities in the care of acute cholecystitis: A national study Anand Singla BA, Melissa M Murphy MD, Sing-Chau Ng MS, YouFu Li MD, Jennifer F Tseng MD, FACS, Shimul A Shah MD, FACS University of Massachusetts Medical School, Worcester, MA
RESULTS: In the most segregated counties, with the highest Segregation Index each percentage point increase in Hispanic or Black population was associated with a statistically significant decrease in inpatient surgery volume (p ⬍ 0.0001), specialized surgical facilities (p ⬍ 0.0001), number of cardiothoracic surgeons (p ⬍ 0.0001), number of colorectal surgeons (p ⬍ 0.0001), number of radiation oncologists (p ⬍ 0.0001), and number of gastroenterologists (p ⬍ 0.0001). In the least segregated counties, these associations showed no statistical significance.
INTRODUCTION: Racial differences in utilization and outcomes of major surgical procedures have been shown previously. We sought to investigate whether racial disparities exist in common diseases like acute cholecystitis (AC). METHODS: Discharge records (Nationwide Inpatient Sample) for all adult admissions (n ⫽ 205,119) with a primary diagnosis of AC from 1998 to 2006 were examined. A cohort of only white and black patients was created. Covariates included other patient demographics, comorbidities, and hospital characteristics. Separate logistic regression models were created to identify areas of disparity in clinical care.
CONCLUSIONS: In counties with the highest Segregation Index, an increase in the black or Hispanic population was associated with a decrease in the availability and utilization of specialized surgical services after adjustment for socioeconomic and health characteristics.
RESULTS: 86.0% of patients received a cholecystectomy; 89.9% were laparoscopic (LC). 22,308 (10.9%) were identified as black. Compared with white patients, black patients tended to be female (74.5% vs 58.7%), have Medicaid insurance (19.1% vs 6.2%), lower income (82.4% vs 66.8%), and have more than 1 comorbidity (69.3% vs 65.6%) (p ⬍ 0.0001). After adjusting for hospital and patient factors, black patients were less likely to receive a cholecystectomy (odds ratio [OR], 0.70). For those who did, blacks were less likely to receive LC (OR, 0.70) and underwent open conversion more often (OR, 1.23). Blacks were also more likely to experience a postoperative complication (OR, 1.17), have a prolonged LOS (OR, 1.73), and more likely to die during the hospital stay when compared with white patients (OR, 1.37; 95% confidence interval, 1.17 to 1.59).
Insurance status and geography but not race affect mortality in penetrating trauma victims Fuad Alkhoury MD, Steven Yood MD, MPH, Marianne Ulcickas Yood PhD, Jeremiah T Martin MD, Karen Wells BA, Scott Helton MD, Randall Zuckerman MD, FACS Hospital of Saint Raphael, New Haven, CT INTRODUCTION: A number of studies have demonstrated disparities between racial groups in trauma patients, with African American patients having worse outcomes. We examined the independent effect of insurance status and race on mortality following penetrating trauma, adjusting for the severity of injury, geography, and other demographic factors.
CONCLUSIONS: Our findings raise concerns about the delivery of care and outcomes for black compared with white patients with common surgical diseases like AC. Future studies should investigate possible social, biologic, and economic reasons for these disparities.
METHODS: Using data from the National Trauma Data Bank years 2001–2006, patients greater than 16 years of age with penetrating trauma were identified. A multiple logistic regression analysis was performed to determine differences in survival, adjusting for age, insurance status, hospital setting, ACS trauma designation, geographical region, and injury severity score (ISS).
The segregation index as a predictor of access to specialized surgical care by minority populations in the United States
RESULTS: A total of 139,950 patients were identified. 39% were African American, and 16% were Hispanic. After adjustment for covariates, African American patients did not have an increased risk of death (adjusted odds ratio (aOR) ⫽ 0.84; 95% confidence interval (CI), 0.80–0.89), nor did Hispanic patients (aOR⫽ 0.75; 95% CI, 0.70–0.80). Uninsured patients were 2 times more likely to die when compared with insured patients (aOR ⫽ 2.13; 95% CI, 1.94–2.35). Patients from the Northeast were 52% more likely to survive (aOR ⫽ 0.48; 95% CI, 0.42–0.54) as compared with other regions.
Awori J Hayanga MD, MPH, Heather Kaiser MPH, David Chang MBA, PhD, Martin A Makary MD, MPH, FACS University of Michigan, Ann Arbor, MI INTRODUCTION: Minority groups in the United States (US) have comparatively poorer access to a range of health care services. Access remains a function of opportunity and utilization and may be influenced by the level of segregation within a county. We hypothesized that varying levels of segregation, as determined by the Segregation Index, may determine access to specialized surgical care.
CONCLUSIONS: In this study using a nationwide database, lack of health insurance independently predicted mortality after penetrating trauma. Race was not an independent predictor of mortality after penetrating trauma. Residing in the Northeast had a protective effect. Reason for this is unknown and requires further analysis and study.
METHODS: A cross-sectional analysis was performed on data from the 2004 Area Resource File (ARF). Each county in the US was categorized into 1 of 3 levels: most, moderately, or least segregated using the Segregation Index. Multivariable linear regression analysis
© 2009 by the American College of Surgeons Published by Elsevier Inc.
ISSN 1072-7515/09/$34.00
S98