Faculty Collaboration Database

Explaining racial disparities in outcomes after cardiac surgery: the role of hospital quality. JAMA Surg 2014 Mar;149(3):223-7

Date

01/10/2014

Pubmed ID

24402245

DOI

10.1001/jamasurg.2013.4041

Scopus ID

2-s2.0-84897831077 (requires institutional sign-in at Scopus site)   185 Citations

Abstract

IMPORTANCE: Racial disparities in mortality rates after coronary artery bypass graft (CABG) surgery are well established. We have yet to fully understand how care at high-mortality, low-quality hospitals contributes to racial disparities in surgical outcomes.

OBJECTIVE: To determine the effects of hospital quality on racial disparities in mortality rates after CABG surgery.

DESIGN, SETTING, AND PARTICIPANTS: The national Medicare database (2007-2008) was used to identify 173,925 patients undergoing CABG surgery in US hospitals.

MAIN OUTCOMES AND MEASURES: Our primary measure of quality was the risk-adjusted mortality rate for each hospital. Logistic regression was used to determine the relationship between race and mortality rates, accounting for patient characteristics, socioeconomic status, and hospital quality.

RESULTS: Nonwhite patients had 33% higher risk-adjusted mortality rates after CABG surgery than white patients (odds ratio [OR], 1.33; 95% CI, 1.23-1.45). In hospitals treating the highest proportion of nonwhite patients (>17.7%), the mortality was 4.8% in nonwhite and 3.8% in white patients. When assessed independently, differences in hospital quality explained 35% of the observed disparity in mortality rates (OR, 1.22; 95% CI, 1.12-1.34). We were able to explain 53% of the observed disparity after adjusting for differences in socioeconomic status and hospital quality. However, even after these factors were taken into account, nonwhite patients had a 16% higher mortality (OR, 1.16; 95% CI, 1.05-1.27).

CONCLUSIONS AND RELEVANCE: Hospital quality contributes significantly to racial disparities in outcomes after CABG surgery. However, a significant fraction of this racial disparity remains unexplained. Efforts to decrease racial disparities in health care should focus on underperforming centers of care treating disproportionately high numbers of nonwhite patients.

Author List

Rangrass G, Ghaferi AA, Dimick JB

Author

Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Coronary Artery Bypass
Coronary Disease
Female
Health Status Disparities
Hospital Mortality
Hospitals
Humans
Logistic Models
Male
Medicare
Odds Ratio
Quality Indicators, Health Care
Quality of Health Care
Social Class
United States