Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York.
Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, New York.
JAMA Netw Open. 2022 May 2;5(5):e2213527. doi: 10.1001/jamanetworkopen.2022.13527.
Racial minority groups account for 70% of excess deaths not related to COVID-19. Understanding the association of the Centers for Medicare & Medicaid Services' (CMS's) moratorium delaying nonessential operations with racial disparities will help shape future pandemic responses.
To evaluate the association of the CMS's moratorium on elective operations during the first wave of the COVID-19 pandemic among Black individuals, Asian individuals, and individuals of other races compared with White individuals.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study assessed a 719-hospital retrospective cohort of 3 470 905 adult inpatient hospitalizations for major surgery between January 1, 2018, and October 31, 2020.
The first wave of COVID-19 infections between March 1, 2020, and May 31, 2020.
The main outcome was the association between changes in monthly elective surgical case volumes and the first wave of COVID-19 infections as a function of patient race, evaluated using negative binomial regression analysis.
Among 3 470 905 adults (1 823 816 female [52.5%]) with inpatient hospitalizations for major surgery, 70 752 (2.0%) were Asian, 453 428 (13.1%) were Black, 2 696 929 (77.7%) were White, and 249 796 (7.2%) were individuals of other races. The number of monthly elective cases during the first wave was 49% (incident rate ratio [IRR], 0.49; 95% CI, 0.486-0.492; P < .001) compared with the baseline period. The relative reduction in unadjusted elective surgery cases for Black (unadjusted IRR, 0.99; 95% CI, 0.97-1.01; P = .36), Asian (unadjusted IRR, 1.08; 95% CI, 1.03-1.14; P = .001), and other race individuals (unadjusted IRR, 0.97; 95% CI, 0.95-1.00; P = .05) during the surge period compared with the baseline period was very close to the change in cases for White individuals. After adjustment for age, sex, comorbidities, and surgical procedure, there was still no evidence that the first wave of the pandemic was associated with disparities in access to elective surgery.
In this cross-sectional study, the CMS's moratorium on nonessential operations was associated with a 51% reduction in elective operations. It was not associated with greater reductions in operations for racial minority individuals than for White individuals. This evidence suggests that the early response to the pandemic did not increase disparities in access to surgical care.
少数民族群体占与 COVID-19 无关的超额死亡人数的 70%。了解医疗保险和医疗补助服务中心（CMS）推迟非必要手术的禁令与种族差异之间的关联，将有助于塑造未来的大流行应对措施。
评估 CMS 在 COVID-19 大流行第一波期间对黑人、亚洲人和其他种族个体与白人个体之间选择性手术暂停的关联。
设计、设置和参与者：本横断面研究评估了 2018 年 1 月 1 日至 2020 年 10 月 31 日期间在 719 家医院进行的 3470905 例成人主要手术住院的回顾性队列。
COVID-19 感染的第一波，从 2020 年 3 月 1 日至 5 月 31 日。
主要结局是评估患者种族作为功能因素的变化与 COVID-19 感染第一波之间的关联，使用负二项式回归分析进行评估。
在 3470905 名（女性 1823816 名[52.5%]）因主要手术住院的成年人中，有 70752 名（2.0%）为亚洲人，453428 名（13.1%）为黑人，2696929 名（77.7%）为白人，249796 名（7.2%）为其他种族。与基线期相比，第一波的每月选择性病例数减少了 49%（发病率比[IRR]，0.49；95%CI，0.486-0.492；P<0.001）。黑人（未调整 IRR，0.99；95%CI，0.97-1.01；P=0.36）、亚洲人（未调整 IRR，1.08；95%CI，1.03-1.14；P=0.001）和其他种族个体（未调整 IRR，0.97；95%CI，0.95-1.00；P=0.05）在手术激增期间未调整手术病例的相对减少与基线期非常接近。在调整年龄、性别、合并症和手术程序后，仍然没有证据表明大流行的第一波与选择性手术机会的差异有关。
在这项横断面研究中，CMS 对非必要手术的禁令与选择性手术减少了 51%有关。它与少数民族个体的手术减少幅度没有比白人个体更显著的差异。这一证据表明，对大流行的早期反应并没有增加手术护理机会的差异。
