Understanding Racial and Ethnic Disparities in Postsurgical Complications Occurring in U.S. Hospitals. - PubMed - NCBI
Health Serv Res. 2017 Feb;52(1):220-243. doi: 10.1111/1475-6773.12475. Epub 2016 Mar 9.
Understanding Racial and Ethnic Disparities in Postsurgical Complications Occurring in U.S. Hospitals.
Abstract
OBJECTIVE:
To examine the role of patient, hospital, and community characteristics on racial and ethnic disparities in in-hospital postsurgical complications. DATA SOURCES:
Healthcare Cost and Utilization Project, 2011 State Inpatient Databases; American Hospital Association Annual Survey of Hospitals; Area Health Resources Files; Centers for Medicare & Medicaid Services Hospital Compare database. METHODS:
Nonlinear hierarchical modeling was conducted to examine the odds of patients experiencing any in-hospital postsurgical complication, as defined by Agency for Healthcare Research and Quality Patient Safety Indicators. PRINCIPAL FINDINGS:
A total of 5,474,067 inpatient surgical discharges were assessed using multivariable logistic regression. Clinical risk, payer coverage, and community-level characteristics (especially income) completely attenuated the effect of race on the odds of postsurgical complications. Patients without private insurance were 30 to 50 percent more likely to have a complication; patients from low-income communities were nearly 12 percent more likely to experience a complication. Private, not-for-profit hospitals in small metropolitan or micropolitan areas and higher nurse-to-patient ratios led to fewer postsurgical complications. CONCLUSIONS:
Race does not appear to be an important determinant of in-hospital postsurgical complications, but insurance and community characteristics have an effect. A population-based approach that includes improving the socioeconomic context may help reduce disparities in these outcomes. © Health Research and Educational Trust.
KEYWORDS:
Postsurgical complications; community socioeconomic status; health disparities; health insurance; racial/ethnic differences in health care; surgery
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