African-Americans are much less likely to receive surgical treatment at hospitals and from physicians who perform high volumes of specialized procedures, a new study led by the Yale School of Public Health has found.
The researchers examined tens of thousands of patients and found that African-Americans were “significantly” less likely than their white peers to be operated on for many potentially life-threatening conditions at hospitals and by surgeons who performed the highest number of procedures for various cancers, cardiovascular diseases and hip replacement.
“For many surgical procedures, evidence suggests an association between how many procedures a hospital or surgeon performs and the health outcomes of their patients. The more of a given procedure a physician performs, the better he or she will be at doing it, and hence the better the patient’s outcome,” said Andrew J. Epstein, Ph.D., assistant professor at School of Public Health and the study’s lead author.
This means that many minorities with serious medical conditions are finding treatment in hospitals and with surgeons who have performed fewer of the procedures needed to address their medical condition.
Epstein, along with Mark J. Schlesinger, Ph.D., professor at School of Public Health, and Bradford H. Gray, Ph.D., of the Urban Institute, studied 133,821 patients who underwent one of 10 surgical procedures in New York City. They found that for nine of these procedures, African-Americans were less likely to be treated by both a high-volume hospital and a high-volume surgeon. Averaged across these nine procedures, the difference between African-American and white patients was 12.9 percentage points.
Compared with white patients, those of Asian descent were significantly less likely to use high-volume hospitals and surgeons for five of the procedures studied, and Hispanics were less likely to use high-volume hospitals and surgeons for four of the 10 procedures, Epstein said.
As calls for making the health care system more consumer-directed grow louder, these findings suggest that minority patients may need additional resources and assistance in finding and accessing high-quality medical providers.
The researchers found that the white patients in the study were generally older and lived in the city’s wealthier enclaves. They were also more likely to be covered by Medicare than their peers in the other groups and less likely to be without health insurance. The significant differences across racial/ethnic groups in use of high-volume hospitals and surgeons persisted after adjusting for these and other factors.
Epstein said that future research will concentrate on identifying the causes of these disparities, including distinguishing the importance of geographic location in determining which hospitals are used from referral patterns that influence which surgeons are used within the same hospital.
The research is published in the journal Archives of Surgery.