Among older Medicare beneficiaries who underwent surgical treatment for diverticulitis, black race was associated with increased risk of urgent/emergency surgery, high risk of in-hospital mortality and higher total hospital charges, according to a report in the November issue of Archives of Surgery, one of the JAMA/Archives journals.
"Observed racial disparities in diverticulitis surgery have been attributed to differences in health insurance status and medical comorbidity," the authors write as background information in the article. "This study explores the hypothesis that race affects mortality independent of insurance status and comorbidities in an older population with diverticulitis [small, bulging pouches of the inner lining of the intestine that become inflamed or infected]."
Eric B. Schneider, Ph.D., of the Center for Surgical Trials and Outcomes Research, The Johns Hopkins School of Medicine, Baltimore, and colleagues conducted a retrospective analysis of Medicare Provider Analysis and Review inpatient data from 52,220 patients 65 years of age and older who were characterized as either black or white by the Center for Medicare and Medicaid Services and who underwent surgical treatment for diverticulitis between January 2004 and December 2007.
Of the 52,220 patients, 49,937 (95.6 percent) were white and 2,283 (4.4 percent) were black. The authors found that compared with white patients, black patients had higher rates of emergency admission for diverticulitis surgery (67.8 percent vs. 54.7 percent), and higher in-hospital mortality (6.8 percent vs. 5 percent). The mean (average) length of hospital stay was longer for black patients than for white patients (15.2 days vs. 11.4 days) and mean total hospital charges were also greater for black patients compared with white patients ($93,494 vs. $65,973).
After adjusting for age, sex and medical comorbidity, black patients had a 26 percent increased risk of having urgent or emergency diverticulitis surgery compared with white patients. The authors also found that black race was associated with a 28 percent increased risk of in-hospital mortality, regardless of admission type. Additionally, black patients were more likely to be readmitted to inpatient care within 30 days of discharge.
"This study of a large group of older Medicare beneficiaries with known medical comorbidities, all of whom underwent surgical treatment for diverticulitis, found that black race was associated with increased risk of emergency admission and in-hospital mortality and substantially higher total treatment charges," the authors conclude. "The underlying mechanisms that lead to higher rates of emergency vs. elective admissions, greater risk of in-hospital mortality and substantially greater hospital expenses for blacks need to be elucidated so that interventions can be developed to eliminate the premature mortality and greater costs experienced by blacks."
- E. B. Schneider, A. Haider, A. J. Sheer, H. L. Hambridge, D. C. Chang, J. B. Segal, A. W. Wu, A. O. Lidor. Differential Association of Race With Treatment and Outcomes in Medicare Patients Undergoing Diverticulitis Surgery. Archives of Surgery, 2011; 146 (11): 1272 DOI: 10.1001/archsurg.2011.280
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