Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
J Am Coll Surg. 2013 Mar;216(3):482-92.e12. doi: 10.1016/j.jamcollsurg.2012.11.014. Epub 2013 Jan 11.
It is well known that there are significant racial disparities in health care outcomes, including surgery. However, the mechanisms that lead to these disparities are still not fully understood. In this comprehensive review of the currently published surgical disparity literature in the United States, we assess racial disparities in outcomes after surgical procedures, focusing on patient, provider, and systemic factors. The PubMed, EMBASE, and Cochrane Library electronic databases were searched with the keywords: healthcare disparities AND surgery AND outcome AND US. Only primary research articles published between April 1990 and December 2011 were included in the study. Studies analyzing surgical patients of all ages and assessing the endpoints of mortality, morbidity, or the likelihood of receiving surgical therapy were included. A total of 88 articles met the inclusion criteria. This evidence-based review was compiled in a systematic manner, relying on retrospective, cross-sectional, case-control, and prospective studies in the absence of Class I studies. The review found that patient factors such as insurance status and socioeconomic status (SES) need to be further explored, as studies indicated only a premature understanding of the relationship between racial disparities and SES. Provider factors such as differences in surgery rates and treatment by low volume or low quality surgeons also appear to play a role in minority outcome disparities. Finally, systemic factors such as access to care, hospital volume, and hospital patient population have been shown to contribute to disparities, with research consistently demonstrating that equal access to care mitigates outcome disparities.
众所周知，医疗保健结果存在显著的种族差异，包括手术。然而，导致这些差异的机制仍不完全清楚。在对美国目前已发表的外科差异文献进行的全面综述中，我们评估了手术后结果的种族差异，重点关注患者、提供者和系统因素。使用关键词：医疗保健差异和手术和结果和美国，在 PubMed、EMBASE 和 Cochrane Library 电子数据库中进行了搜索。仅包括 1990 年 4 月至 2011 年 12 月期间发表的原始研究文章。研究分析了所有年龄段的手术患者，并评估了死亡率、发病率或接受手术治疗的可能性等终点。共有 88 篇文章符合纳入标准。本循证综述是系统地编制的，依赖于回顾性、横断面、病例对照和前瞻性研究，没有 I 类研究。综述发现，患者因素，如保险状况和社会经济地位（SES）需要进一步探讨，因为研究表明，种族差异与 SES 之间的关系只有初步的理解。提供者因素，如手术率和低数量或低质量外科医生的治疗差异，似乎也在少数民族结果差异中起作用。最后，系统因素，如获得护理的机会、医院容量和医院患者人群，已被证明会导致差异，研究一致表明，平等获得护理可以减轻结果差异。
