Income, race, and surgery in Maryland.

Abstract

BACKGROUND. We describe common surgical and medical hospital admission rates for Maryland residents, exploring systematic effects of race and income. METHODS. The data comprise Maryland hospital discharges and population estimates for 1985 to 1987. Patient income is the race-specific median family income of residence zip code. Logistic regression is used to measure incidence by race, income, and residence for surgical and medical reasons for admission. RESULTS. Population rates for discretionary orthopedic, vascular, and laryngologic surgery tend to increase with community income levels. Coronary and carotid artery surgery rates are two to three times higher among Whites. The more discretionary the procedure, the lower is the relative incidence among Blacks. By contrast, admission rates for most medical reasons decline with increasing income levels and are elevated among Blacks. The affluent receive coronary artery procedures whereas the poor are hospitalized for coronary artery disease. CONCLUSIONS. Blacks and the poor appear to have higher illness burdens requiring hospital care. Discretionary surgeries have a White predominance and increase with income; medical admissions have a Black predominance and decline with income. Race and community income level are important factors in differential hospital utilization rates.

What Rate of Utilization is Appropriate in Musculoskeletal Care?

“…Gittelsohn et al found considerable variability in discretionary surgery across income groups; for example highincome areas had a 42% higher rate of laminectomy than did low-income areas [8]. Similarly, a more recent evaluation of spine surgery finds a strong monotonic increase in the rate of spine surgeries by deciles of zip code level income (Fig.…”

“…Examples of supply-sensitive care include nonemergent physician visits, subspecialty referrals, hospital admissions for chronic conditions, and many diagnostic imaging studies. The rate of these services varies dramatically with the capacity of the local healthcare system [8]. While things like physician visits are often not ''big ticket'' items, overall Medicare spending in a region is strongly associated with these supply-sensitive services.…”

“…As far back as 1991, Gittelsohn and colleagues reported major differences in the rate of discretionary surgery such as lumbar laminectomy according to race [8]. They found that the rate of laminectomy among blacks was less than half the rate among whites.…”

“…In addition, variations have been found in the rates of certain musculoskeletal procedures among racial, ethnic, and socioeconomic groups [4,8,24]. These large variations have not been explainable by differences among the patient populations [7,28], and the persistence of these large differences in the number of procedures performed in different regions begs the question, ''Which rate is right?'…”

Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18, 297 patients across 774 US hospitals using the National Inpatient Sample (2002−2011)

“…3,10,15,25,35,37,44,53,62,66 In our analysis, African American race was noted to confer a higher likelihood than Caucasian race of unfavorable discharge (OR 1.69; 95% CI 1.35-2.12; p < 0.0001), prolonged LOS (OR 1.74; 95% CI 1.29-2.36; p = 0.003), high-end hospital charges (OR 1.57; 95% CI 1.09-2.24; p = 0.022), cardiac complications (OR 3.04; 95% CI 1.51-6.11; p = 0.003), and DVT (OR 2.73; 95% CI 1.04-7.17; p = 0.043) after benign tumor resection. Inequalities in access to routine health care services, secondary to lower socioeconomic conditions, for maintaining modifiable preexisting comorbidities seem a reasonable explanation for the racial disparity seen in outcomes for African Americans.…”