A new UCLA study shows Black men are more likely to die following surgery than white men, white women, and Black women. Researchers believe inequity in healthcare access may be the root cause.
The data published in the BMJ on March 1 evaluates mortality for multiple common surgical procedures across the United States. Following 30 days after surgery, numbers showed Black men 50% more likely to die from surgery than white men.
Individuals belonging to the Medicare fee-for-service beneficiaries from the 100% Medicare inpatient file from 2016 to 2018 were used for the study. Only those aged 65 to 99 years were included, ending up with 1.87 million Black and white beneficiaries involved in the review.
The eight surgery procedures researchers chose to evaluate include repair of abdominal aortic aneurysm, appendectomy, cholecystectomy, colectomy, coronary artery bypass surgery, hip replacement, knee replacement, and lung resection.
Researchers discovered the average overall mortality rate following the surgery was 3.05% for Black men, versus 2.69% for white men, 2.38% for white women, and 2.18% for Black women. Similar patterns were found in elective surgeries.
For non-elective surgeries, no difference in mortality was noticed between Black men and white men. Researchers did notice lower mortality in white women and black women versus their male counterparts.
In a UCLA release, study lead and assistant professor of medicine at the David Geffen School of Medicine at UCLA, Dan Ly, Ph.D., reveals the significance of his team’s findings.
"While a fair bit is known about such inequities, we find in our analyses that it's specifically Black men who are dying more, and they are dying more after elective surgeries, not urgent and emergent surgeries," Ly said. "Our findings point to possibilities such as poorer pre-optimization of co-morbidities prior to surgery, delays of care due to structural racism and physician bias, and worse stress and its associated physical burden on Black men in the United States."
Researchers believe systemic racism is affecting the healthcare system. In their discussion, investigators cite the lack of high-quality health care in predominantly Black communities. Additionally, researchers believe Black men in the U.S. face high stress that may contribute to poor health.
According to the CDC, Black men have the lowest life expectancy versus Black women, white men, and women. Data available from 2018 shows the average life expectancy for a Black man to be 71.9 years, versus 78 for Black women and 76.2 for white men. White women have the highest life expectancy at 81.8 years.
Previous projects align with the findings from UCLA. One study from England and Wales discovered mortality was higher in Black infants undergoing cardiac surgery than among white infants. However, far fewer subjects were involved in this project.
Despite their detailed investigation, Ly and his team list some limitations, such as only including Black and white men and women. The study only featured eight surgical procedures; therefore, researchers can not assume the same outcome for other procedures. Also, the study failed to list lifestyle factors, including obesity prevalence and smoking history. The U.S. Department of Health and Human Services says nearly 80% of Black women are overweight or obese. Obesity can lead to serious complications such as high blood pressure or high cholesterol, type 2 diabetes, and breathing complications.
Obesity is also affected by racial disparities. Low-income areas with large Black populations are likelier to have less nutritious food options than high-income areas. Perhaps a combination of racial disparities in health access and pre-existing conditions is the cause of higher mortality after surgery.
Black Americans are also more likely to be uninsured than their white counterparts. The U.S. National Health Statistics Report from 2021 shows 13.8% of non-Hispanic Blacks are uninsured versus 8.8% of non-Hispanic whites. Hispanic Americans are the largest uninsured group at 28.7%, with non-Hispanic Asians the lowest at 5.9%
With the UCLA study largely focussing on Black and white individuals, Hispanic and Asian data would be needed to compare a thorough investigation. As always, researchers admit more in-depth studies featuring more demographics are needed to paint a better picture.
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