According to a study published in the journal Pediatrics on Monday, black children are more than three times more likely to die within a month after surgery than white children.
Disparities in surgical outcomes between black and white patients have been well established, and the researchers attribute part of the difference to the higher rates of chronic conditions among black people. But this study, which analyzed data from 172,549 children, highlights racial disparities in health outcomes, even when comparing healthy children.
The researchers found that black children were 3.4 times more likely to die within a month after surgery and 1.2 times more likely to develop postoperative complications. The authors conducted a retrospective data-based study of children who underwent surgery from 2012 to 2017.
Olubukola Nafiu, lead author of the study and a pediatric anesthesiologist at Nationwide Children’s Hospital in Columbus, Ohio, said the authors were not surprised to find that healthy children generally had extremely low rates of mortality and complications after surgery. . But what surprised them was the magnitude of the difference in mortality and complication rates by race.
“The hypothesis we had when we started was that if you were studying a relatively healthy cohort of patients, there should be no difference in the results,” said Dr. Nafiu.
The authors, in their article, recognized the limitations of the study: they did not explore the site of care where patients received their treatments or the status of the patient’s insurance, which can be used as an indicator of socioeconomic status. This meant that they could not explain the differences in the quality of care received by the patients or the financial background of the patients.
Another limitation was that because postoperative mortality and complications are so rare among healthy children, most cases may come from a few hospitals, Dr. Nafiu said.
But while black people are more likely to receive care in low-performing hospitals, that may not be the main factor driving the gap this study found, Dr. Nafiu said. All of the hospitals examined in the study were part of the National Surgical Quality Improvement Program, a voluntary program, which means they had the resources to be part of the program and the belief that quality improvement is important.
Adil Haider, dean of the medical school at Aga Khan University, who was not involved in the study, said he was telling a key piece of the story about racial disparities in surgical outcomes, but that there were still many questions about what drives disparities.
“The real reality is that we just need to start reporting data within hospitals and when we add hospitals, by race and by insurance status, so that we know that, in a given hospital, people of different backgrounds are receiving the same results.” , Said Dr. Haider, former director of the Center for Surgery and Public Health, a joint initiative of Brigham and Women’s Hospital, Harvard Medical School and Harvard TH Chan School of Public Health.
Many studies have shown that people of color receive less and often worse care than white Americans for reasons including lower rates of health coverage and racial stereotypes.
But a study, published in June by JAMA, suggested some signs of improvement. That research paper, which looked at more than 20,000 extremely premature babies, suggested that racial disparities in death rates had narrowed from 2002 to 2016. The results were significant because racial disparities around maternal mortality, childbirth premature and infant mortality have been persistent.
Dr. Nia Heard-Garris, a pediatric researcher at Ann & Robert H. Lurie Children’s Hospital in Chicago, who was not involved in the study, said the research was significant because it was based on a large national sample.
“We are not talking about a small health system, within a small city, or even a big city, we are talking about trends at the national level,” said Dr. Heard-Garris, who heads the Section of the American Academy of Pediatrics on Healthy Minorities, Equity and Inclusion. “As the mother of a black child who will need surgery at some point, it is very scary.”
