- A study performed by researchers at the University of Michigan Health System reveals a disturbing 33% disparity between the mortality rates of white patients after coronary artery bypass graft (CABG) surgery and those that identify as nonwhite. Access to high quality hospitals was seen as one of the major factors impacting the significant difference between racial survival rates, says lead researcher Govind Rangrass, MD.
The researchers used Medicare data on 173,000 patients who underwent CABG surgery between 2007 and 2008, and found that while white patients had a mortality rate of 3.8%, the risk of a nonwhite patient dying after the procedure was nearly five percent. The team was able to account for about half of the reasons associated with the gap, which include socioeconomic status and individual patient-related factors.
But the researchers couldn’t identify all the reasons why minority patients experience such drastically different mortality rates. “We were able to explain 53% of the observed disparity after adjusting for differences in socioeconomic status and hospital quality,” Rangrass explains. “However, even after these factors were taken into account, nonwhite patients had a 16% higher mortality.”
A recent survey by the Blue Shield of California Foundation may shed some additional light on the findings. The report indicated that low-income and minority patients feel less connected to their providers, less in control of their treatment, and less likely to believe they are receiving high quality care due to factors like language barriers and the lack of a dedicated primary care provider. “The predictive power of income drops by half when these factors are taken into account,” the survey explains, “a major step on the road to more equitable care for low-income Californians in comparison with their higher-income counterparts.”
Poor provider communication, a convoluted referrals process, and the high costs associated with seeking elective surgery may lead nonwhite patients to put off services until the condition has become unavoidably acute, which may then lead to worse outcomes after surgery, Rangrass conjectures. Providing better access to high-quality hospitals for minority patients may improve their outcomes.
“Hospital quality contributes significantly to racial disparities in outcomes after CABG surgery,” the study concludes. “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.”