Racial Disparities at Mixed-Race and Minority Hospitals: Treatment of African American Males with High-Grade Splenic Injuries

Christopher J. Tignanelli; Bradly Watarai; Yunhua Fan; Ashley Petersen; Mark Hemmila; Lena Napolitano; Stephanie Jarosek; Anthony Charles

doi:10.1177/0003134820918262

Racial Disparities at Mixed-Race and Minority Hospitals: Treatment of African American Males with High-Grade Splenic Injuries

Christopher J. Tignanelli, Bradly Watarai, Yunhua Fan, Ashley Petersen, Mark Hemmila, Lena Napolitano, Stephanie Jarosek, Anthony Charles

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

INTRODUCTION: Racial and socioeconomic disparities in health access and outcomes for many conditions are well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American (AA) versus white males with high-grade splenic injuries.

METHODS: Data from the National Trauma Data Bank was utilized from 2007 to 2015. A total of 24 855 AA or white males with high-grade splenic injuries were included. Multilevel mixed effects regression analysis was used to evaluate disparities in outcomes and resource allocation.

RESULTS: Mortality was significantly higher for AA males at mixed-race (odds ratio [OR] 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2; P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08).

DISCUSSION: While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.

Original language	English (US)
Pages (from-to)	441-449
Number of pages	9
Journal	American Surgeon
Volume	86
Issue number	5
DOIs	https://doi.org/10.1177/0003134820918262
State	Published - May 2020

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Mark R. Hemmila receives support from Blue Cross Blue Shield of Michigan and Blue Care Network (a nonprofit mutual company) for conduct of The Michigan Trauma Quality Improvement Program with a Collaborative Quality Initiatives grant. This research was funded by a grant awarded to CJT from the University of Minnesota’s Center for Healthy

Publisher Copyright:
© 2020 Southeastern Surgical Congress. All rights reserved.

Keywords

Adolescent
Adult
African Americans
Aged
European Continental Ancestry Group
Healthcare Disparities/statistics & numerical data
Hospitals/classification
Humans
Injury Severity Score
Male
Middle Aged
Minority Groups
Spleen/injuries
United States
Young Adult

PubMed: MeSH publication types

Journal Article
Comparative Study

Publisher link

10.1177/0003134820918262

Find It

Find It at U of M Libraries

Cite this

@article{aebaeb4dbcf74b448a05d6eac1d14087,

title = "Racial Disparities at Mixed-Race and Minority Hospitals: Treatment of African American Males with High-Grade Splenic Injuries",

abstract = "INTRODUCTION: Racial and socioeconomic disparities in health access and outcomes for many conditions are well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American (AA) versus white males with high-grade splenic injuries.METHODS: Data from the National Trauma Data Bank was utilized from 2007 to 2015. A total of 24 855 AA or white males with high-grade splenic injuries were included. Multilevel mixed effects regression analysis was used to evaluate disparities in outcomes and resource allocation.RESULTS: Mortality was significantly higher for AA males at mixed-race (odds ratio [OR] 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2; P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08). DISCUSSION: While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.",

keywords = "Adolescent, Adult, African Americans, Aged, European Continental Ancestry Group, Healthcare Disparities/statistics & numerical data, Hospitals/classification, Humans, Injury Severity Score, Male, Middle Aged, Minority Groups, Spleen/injuries, United States, Young Adult",

author = "Tignanelli, {Christopher J.} and Bradly Watarai and Yunhua Fan and Ashley Petersen and Mark Hemmila and Lena Napolitano and Stephanie Jarosek and Anthony Charles",

note = "Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Mark R. Hemmila receives support from Blue Cross Blue Shield of Michigan and Blue Care Network (a nonprofit mutual company) for conduct of The Michigan Trauma Quality Improvement Program with a Collaborative Quality Initiatives grant. This research was funded by a grant awarded to CJT from the University of Minnesota{\textquoteright}s Center for Healthy Publisher Copyright: {\textcopyright} 2020 Southeastern Surgical Congress. All rights reserved.",

year = "2020",

month = may,

doi = "10.1177/0003134820918262",

language = "English (US)",

volume = "86",

pages = "441--449",

journal = "American Surgeon",

issn = "0003-1348",

publisher = "Southeastern Surgical Congress",

number = "5",

}

TY - JOUR

T1 - Racial Disparities at Mixed-Race and Minority Hospitals

T2 - Treatment of African American Males with High-Grade Splenic Injuries

AU - Tignanelli, Christopher J.

AU - Watarai, Bradly

AU - Fan, Yunhua

AU - Petersen, Ashley

AU - Hemmila, Mark

AU - Napolitano, Lena

AU - Jarosek, Stephanie

AU - Charles, Anthony

N1 - Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Mark R. Hemmila receives support from Blue Cross Blue Shield of Michigan and Blue Care Network (a nonprofit mutual company) for conduct of The Michigan Trauma Quality Improvement Program with a Collaborative Quality Initiatives grant. This research was funded by a grant awarded to CJT from the University of Minnesota’s Center for Healthy Publisher Copyright: © 2020 Southeastern Surgical Congress. All rights reserved.

PY - 2020/5

Y1 - 2020/5

N2 - INTRODUCTION: Racial and socioeconomic disparities in health access and outcomes for many conditions are well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American (AA) versus white males with high-grade splenic injuries.METHODS: Data from the National Trauma Data Bank was utilized from 2007 to 2015. A total of 24 855 AA or white males with high-grade splenic injuries were included. Multilevel mixed effects regression analysis was used to evaluate disparities in outcomes and resource allocation.RESULTS: Mortality was significantly higher for AA males at mixed-race (odds ratio [OR] 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2; P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08). DISCUSSION: While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.

AB - INTRODUCTION: Racial and socioeconomic disparities in health access and outcomes for many conditions are well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American (AA) versus white males with high-grade splenic injuries.METHODS: Data from the National Trauma Data Bank was utilized from 2007 to 2015. A total of 24 855 AA or white males with high-grade splenic injuries were included. Multilevel mixed effects regression analysis was used to evaluate disparities in outcomes and resource allocation.RESULTS: Mortality was significantly higher for AA males at mixed-race (odds ratio [OR] 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2; P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08). DISCUSSION: While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.

KW - Adolescent

KW - Adult

KW - African Americans

KW - Aged

KW - European Continental Ancestry Group

KW - Healthcare Disparities/statistics & numerical data

KW - Hospitals/classification

KW - Humans

KW - Injury Severity Score

KW - Male

KW - Middle Aged

KW - Minority Groups

KW - Spleen/injuries

KW - United States

KW - Young Adult

UR - http://www.scopus.com/inward/record.url?scp=85088351469&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85088351469&partnerID=8YFLogxK

U2 - 10.1177/0003134820918262

DO - 10.1177/0003134820918262

M3 - Article

C2 - 32684029

AN - SCOPUS:85088351469

SN - 0003-1348

VL - 86

SP - 441

EP - 449

JO - American Surgeon

JF - American Surgeon

IS - 5

ER -

Racial Disparities at Mixed-Race and Minority Hospitals: Treatment of African American Males with High-Grade Splenic Injuries

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

Publisher link

Find It

Other files and links

Fingerprint

Cite this