Gahagan John V, Hanna Mark H, Whealon Matthew D, Maximus Steven, Phelan Michael J, Lekawa Michael, Barrios Cristobal, Bernal Nicole P
Department of Surgery, University of California, Irvine School of Medicine, Irvine, California, USA.
Am Surg. 2016 Oct;82(10):921-925.
Disparities in access to health care between white and minority patients are well described. We aimed to analyze the trends and outcomes of cholecystectomy based on racial classification. The Nationwide Inpatient Sample database was reviewed for all patients undergoing cholecystectomy from 2009 to 2012. Patients were stratified as white or non-white. A total of 243,536 patients were analyzed: 159,901 white and 83,635 non-white. Non-white patients had significantly higher proportions of Medicaid (25% vs 9.3%), self-pay (14% vs 7.1%), and no-charge (1.8% vs 0.64%). Non-white patients had significantly higher rates of emergent admission (84% vs 78%) compared with the white patients. Multivariate analysis revealed that non-whites had a significantly longer length of stay [mean difference of 0.14 days, 95% confidence interval (CI) 0.08-0.20] and higher total hospital charges (mean difference of $6748.00, 95% CI 5994.19-7501.81) than whites, despite a lower morbidity (odds ratio 0.94, 95% CI 0.90-0.98). Use of laparoscopy and mortality were not different. These differences persisted on subgroup analysis by insurance type. These findings suggest a gap in access to and outcomes of cholecystectomy in the minority population nationwide.
白人和少数族裔患者在获得医疗保健方面的差异已有详尽描述。我们旨在根据种族分类分析胆囊切除术的趋势和结果。对2009年至2012年期间接受胆囊切除术的所有患者的全国住院患者样本数据库进行了回顾。患者被分为白人或非白人。总共分析了243,536名患者：159,901名白人患者和83,635名非白人患者。非白人患者中医疗补助（25%对9.3%）、自费（14%对7.1%）和免费（1.8%对0.64%）的比例显著更高。与白人患者相比，非白人患者的急诊入院率显著更高（84%对78%）。多变量分析显示，尽管发病率较低（比值比0.94，95%置信区间0.90 - 0.98），但非白人患者的住院时间显著更长[平均差异0.14天，95%置信区间（CI）0.08 - 0.20]，总住院费用更高（平均差异6748.00美元，95%置信区间5994.19 - 7501.81美元）。腹腔镜手术的使用和死亡率没有差异。按保险类型进行亚组分析时，这些差异仍然存在。这些发现表明全国少数族裔人群在胆囊切除术的可及性和结果方面存在差距。
