Black patients are more likely to be injured during surgery and contract avoidable hospital infections than white patients of the same age, gender, and health status who are treated in the same hospital, according to a new study.
A previous study by the same researchers found significant race disparities in adverse hospital safety events, which they concluded could be at least partially attributed to differences in the quality of hospitals where Black and white patients are treated.
But the new study finds that when treated at the same hospital, Black patients are still more likely to have an organ punctured during surgery, develop sepsis after surgery, and experience other adverse safety complications. In fact, researchers found that the disparity persisted even at hospitals with a disproportionately large share of Black patients.
“If they treat more Black patients, you’d think maybe their quality of care for Black patients would be higher,” said Anuj Gangopadhyaya, senior research associate at the Urban Institute and the study’s lead author. “We don’t see that.”
Gangopadhyaya said the findings should be a call to action for health-care systems, states, and Congress.
“They need to take stock of this and be asking why Black and white [patients] are receiving a different standard of care,” he said.
The study is based on thousands of 2017 patient discharge records in 26 states from a database by the Association of Healthcare Research and Quality. The records include patients’ age, race or ethnicity, insurance coverage, and diagnostic and procedure codes.
Among the findings:
Black patients developed pressure ulcers at a rate of about 1.2 cases per 1,000 discharges, compared with a rate of 0.9 per 1,000 discharges among white patients — a statistically significant difference.
The rate of sepsis, a potentially deadly complication of an infection, was 27% higher among at-risk Black patients compared with white patients of the same age, gender, and health status.
Black patients were also more likely to experience postoperative respiratory failure, pulmonary embolism, and perioperative (around the time of surgery) hemorrhage.
“These are measures of hospital-acquired injuries — they don’t depend on the patients’ underlying health before they get to the hospital,” Gangopadhyaya said. “These should be thought of as objective measures of the quality of care patients receive.”
People with underlying health conditions, such as diabetes and heart problems, are more vulnerable to infections and complications after surgery. Black individuals are at greater risk for type 2 diabetes, heart disease, and other chronic health conditions, but Gangopadhyaya said this alone could not explain the disparity. Researchers compared patients with similar diagnoses and hospital procedures in an effort to account for health status.
“Those differences are unlikely to be of the magnitude of the differences we see,” Gangopadhyaya said. “It’s hard to believe that would be driving a 27% difference in postoperative sepsis.”
Researchers found the disparities persisted when they adjusted for type of insurance. Private insurance pays higher rates than Medicare or Medicaid, which other studies have suggested can influence the care patients receive. The disparity was particularly pronounced among patients covered by Medicare, the federally funded health program for older adults and individuals with disabilities.
The findings point to the role systemic discrimination has on the health of Black patients. Bias among providers may influence the type of care they recommend, while algorithms used by hospitals to prioritize care resources often include race.
Hospitals must do more to educate medical staff about recognizing and addressing racial bias in their practice, researchers concluded.
Improving communication and diversity could also narrow the Black-white gap in hospital-acquired illnesses and injuries, Gangopadhyaya said. Miscommunication among care teams has been shown to be more common when treating Black patients.
Increasing the number of Black providers could help patients feel better understood and more comfortable discussing their health status.