Black patients have worse safety outcomes than White patients at the same hospital, study finds

By | July 21, 2021

Dive Brief:

  • Black patients are more likely to experience an adverse safety event than their White counterparts at the same hospital, according to new data from the Urban Institute.
  • Researchers analyzed 11 patient safety indicators and found in six of those, Black adult patients experienced significantly worse patient safety outcomes than White patients of the same age and gender treated in the same hospital. Those disparities persisted even when comparing patients with similar types of insurance coverage.
  • Black patients even experienced worse patient safety events relative to White patients in hospitals that served more Black patients, researchers found.

Dive Insight:

The report published Tuesday is the latest finding health disparities based on a patient’s race, a systemic issue in the U.S. healthcare system recently thrown into stark relief by the coronavirus pandemic.

Urban Institute researchers, funded by the Robert Wood Johnson Foundation, looked at hospital discharge records from 26 states in 2017, and zeroed in on 11 safety measures to get a sense of disparities in care.

Four indicators center on general patient safety and seven center on adverse events around surgical procedures.

For Black adults, adverse safety events related to surgical measures occurred more frequently than general patient safety indicators, the study found. For example, per 1,000 at-risk discharges — discharges for experiencing a specific adverse event — Black patients had rates of postoperative sepsis infections that were 1.3 cases higher than those of White patients in the same age group and gender, and treated in the same hospital.

For context, that difference is roughly 27% of the overall risk of postoperative sepsis infections for Black patients, researchers said.

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Along with postoperative sepsis, Black adults experienced higher rates of press ulcers, catheter-related infections, perioperative hemorrhage or hematoma, postoperative respiratory failure and perioperative pulmonary embolism, relative to White patients.

White patients​ experienced significantly worse quality of care relative to Black patients in the same hospital on two patient safety indicators, while quality of care was similar for Black and White patients on three out of 11 patient safety indicators, the Urban Institute found.

Disparities persisted even among hospitals where more than a quarter of patients were Black. Of the six patient safety indicators where Black patients experienced significantly worse outcomes, disparities remained in five of those in said facilities, researchers said.

The study is the latest in a mountain of research showing significant inequities in the U.S. medical system for non-White individuals. Research from the Urban Institute published in March, for example, found Black adult patients experienced higher rates of hospital-acquired injuries or illnesses than White patients because they were being admitted to inferior hospitals.

However, no studies to date have broadly looked at in-hospital differences in patient safety indicators based on race after implementation of the Affordable Care Act, which greatly expanded insurance coverage in the U.S., the nonprofit Urban Institute said.

“Studies show the health care system fails Black patients regardless of their age, gender, insurance status or where they access care,” Mona Shah, senior program officer at the Robert Wood Johnson Foundation, said in a statement. “The way care is delivered to diverse patients must fundamentally change and achieving equitable outcomes needs to be a health care priority.”

The Biden administration has made addressing health disparities a key prong of its health agenda, as the coronavirus has highlighted stark inequities in medical access and treatment quality.

Black individuals and other groups more likely to die from COVID-19 than White people, and significant racial gaps in receiving vaccinations persist despite the ongoing push to inoculate a greater swath of the U.S. population.

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