Disparities/Minority Health

Black patients are more likely to die after major surgery than white patients

Blacks are 23 to 61 percent more likely to die following certain cardiovascular or cancer surgeries, yet the hospital at which they are treated, rather than their race, accounts for most of this difference in mortality rates. A study, supported in part by the Agency for Healthcare Research and Quality (HS10141), used national Medicare data to identify all patients undergoing one of eight cardiovascular or cancer procedures between 1994 and 1999. Researchers analyzed the data to assess differences in operative mortality (death within 30 days or before hospital discharge) between black and white patients, controlling for patient characteristics such as severity of illness.

Blacks had higher mortality rates than whites for all operations except for lung cancer. These included coronary artery bypass graft surgery (CABG), aortic valve replacement, abdominal aortic aneurysm repair, carotid endarterectomy, radical cystectomy, pancreatic resection, and esophagectomy. Higher mortality rates for blacks undergoing these seven procedures ranged from a 23 percent higher likelihood of death following CABG to a 61 percent higher likelihood after esophagectomy. Adjusting for patient characteristics had a modest or no effect on likelihood of mortality by race; however, there were few differences in mortality by race after accounting for hospital factors.

Hospitals that treated 10 percent or more black patients had higher mortality rates for all eight procedures, for both white and black patients. Black patients were more likely to undergo surgery in very low volume hospitals, and low volume is a risk factor for increased operative mortality. However, some hospitals that treated a large proportion of black patients had higher mortality rates independent of their procedure volume. These findings suggest that racial disparities may be as much about the system in which black patients get their care as about patient- or physician-level factors. They also underscore the need to improve quality of care at poorly performing hospitals.

See "Race and surgical mortality in the United States," by F.L. Lucas, Ph.D., Therese A. Stukel, Ph.D., Arden M. Morris, M.D., M.P.H., and others, in the February 2006 Annals of Surgery 243(2), pp. 281-286.

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