New research published in the Journal of the American College of Surgeons shows African Americans are more than twice as likely as Caucasians to die in the hospital after surgical removal of part of the liver -- an increasingly used procedure for the treatment of liver cancer.
In recent years, a large body of evidence has emerged revealing significant racial disparities in health care and outcomes in the United States. Previous studies have documented racial disparities in surgical mortality after cardiovascular and cancer procedures. Because of such studies, the identification and elimination of these disparities has become a national public health priority.
"Our study shows a racial divide in regards to in-hospital mortality after major hepatectomy," according to Timothy Pawlik, MD, MPH, FACS, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md. "This finding is of special note because of the magnitude of the observed gap in outcomes."
Using hospital discharge data from the Nationwide Inpatient Sample, researchers retrospectively reviewed 3,552 patients who underwent major hepatectomy between 1998 and 2005. The overall racial makeup was 59 percent Caucasian, 6 percent African-American, 5 percent Hispanic, 7 percent Asian/Pacific Islander and 24 percent other or unknown, which included records with missing race and those from states that do not report race.
"There has previously not been any research on racial disparities in the outcomes of liver resection, but it is an important issue to examine as the use of hepatic resection has increased dramatically in the U.S.," added Hari Nathan, MD, department of surgery, Johns Hopkins University School of Medicine and the study's lead investigator. "Given this increase, studies are needed to clarify the nature of this disparity and identify targets for intervention."
The odds of dying following this type of liver operation were twice as high for African Americans compared with Caucasians. After adjustment for clinical, hospital, and socioeconomic risk factors, data revealed that African-American patients were twice as likely to die compared to Caucasian patients (odds ratio 2.15, 95 percent confidence, interval 1.28 to 3.61).
Researchers believe that differences in preoperative health status may underlie some of the observed disparity in outcomes, a theory supported by the finding that African-American patients who died in the hospital as a complication of a hepatectomy did so much sooner than their Caucasian counterparts. Hospital factors may also explain racial disparities in outcomes, insofar as minority patients might receive care at hospitals with generally poorer outcomes.
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