Black, Hispanic children more likely to die after surgery regardless of income status
Children from underrepresented populations, including those who lived in high-income areas, were at higher risk for postsurgical death than white children, a retrospective secondary analysis showed.
“Given that minority children — especially Black and Hispanic children — are more likely to be born into poverty than white children, the common narrative is that the difference in [socioeconomic status] is a primary reason for the racial disparity in the rate of post-surgical death,” Brittany L. Willer, MD, a pediatric anesthesiologist at Nationwide Children’s Hospital in Ohio, said in a press release.
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The researchers examined what Willer called the “intersection of race with socioeconomic status, and its impact on pediatric postoperative outcomes” by analyzing 2006, 2009 and 2012 data from the Healthcare Cost and Utilization Project Kids’ Inpatient Database. They matched non-Hispanic white children across the country in a 1:1 ratio with 79,280 non-Hispanic Black children, 5,344 Native American children, 17,508 Asian children and 116,125 Hispanic children.
The results were presented at ANESTHESIOLOGY, the annual meeting of the American Society of Anesthesiologists.
Willer and colleagues reported that non-Hispanic Black children and Hispanic children whose ZIP code indicated that they lived in the lowest three income quartiles were at greater risk for post-surgical mortality than white children in the same income groups (non-Hispanic Black children OR = 1.5; 95% CI, 1.32-1.7; Hispanic children OR = 1.18; 95% CI, 1.05-1.32). In addition, non-Hispanic Black children and Hispanic children in the highest income quartile also experienced greater post-surgical mortality than their white counterparts.
Also, Hispanic children who belonged to the highest income group had an increased risk for postoperative mortality relative to those Hispanic children in poorer income groups, and Non-Hispanic Black children who belonged to the highest income group had a lower risk for postoperative mortality when compared with non-Hispanic Black children in the poorer income groups. However, both of the risks were insignificant.
“We found no evidence that belonging to the wealthiest group conferred a significant reduction in the excess risk of mortality in any of the minority groups relative to their white peers,” the researchers wrote.
Willer told Healio Primary Care that the findings were both “interesting” and “important for clinicians” to know.
“The bottom line is ... there is no so-called wealth advantage for minority children as there is for white children [whereby] white children of higher income levels and socioeconomic groups experience better health care and surgical outcomes than their poorer counterparts,” she said in an interview. “Interventions aimed toward reducing socioeconomic disparities amongst different race/ethnic populations alone will not fully address persistent differences in pediatric postoperative mortality.”
References:
Overview of the Kids' Inpatient Database (KID). https://www.hcup-us.ahrq.gov/kidoverview.jsp#about. Accessed Nov. 10, 2021.
Willer B, et al. A-4150. Presented at: The ANESTHESIOLOGY annual meeting; Oct. 8-12, 2021; (hybrid meeting).