Structural Racism Fuels Racial Disparities in Surgical Outcomes

A new study suggests that structural racism is causing worse surgical outcomes among Black men.

Researchers out of UCLA found in a study recently published in BMJ that historical lack of quality healthcare access in minority communities may partly explain why surgical mortality rates among Black men are 50 percent higher than those of White men after elective procedures, resulting in surgical outcome racial disparities.

Using Medicare data from 2016 to 2018, the researchers examined racial and sex disparities in surgical outcomes among 1.87 million beneficiaries between 65 and 99 years old. Specifically, the study examined eight commonly performed procedures, both planned and unplanned, such as abdominal aortic repair, appendectomy, cholecystectomy, colectomy, coronary artery bypass, hip replacement, knee replacement, and lung resection.

The study findings showed that after elective surgery, the likelihood of death within 30 days was 50 percent higher for older Black men than White men, White women, and Black women.

Furthermore, Black men had a higher adjusted mortality rate even after accounting for other differences between patients, researchers stated. The mortality rate for Black men after surgery was about 3.05 percent within 30 days of both urgent and elective surgery, compared to 2.69 percent for White men, 2.38 percent for White women, and 2.18 percent for Black women.

The disparities were also present when examining elective surgeries, with Black men having a mortality rate of 1.30 percent, compared to 0.85 percent for White men, 0.82 percent for White women, and 0.79 percent for Black women. This difference between Black and White men was evident as early as seven days after surgery and remained even 60 days after surgery.

"While a fair bit is known about such inequities, we find in our analyses that it's specifically Black men who are dying more, and they are dying more after elective surgeries, not urgent and emergent surgeries," Dan Ly, MD, assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, said in a press release.

"Our findings point to possibilities such as poorer pre-optimization of co-morbidities prior to surgery, delays of care due to structural racism and physician bias, and worse stress and its associated physical burden on Black men in the United States,” Ly continued.

The study suggests that structural racism — the impact of racial discrimination across societal systems, including healthcare­ — may partially explain the findings of racial disparities in surgical outcomes. 

Researchers noted that hospitals in predominantly Black neighborhoods often lack high-quality healthcare resources, including advanced surgical specialists and diagnostic tests. Low-quality hospital access can cause treatment delays, resulting in more advanced diseases and more complex surgeries.

Similarly, Black individuals are more likely to reside in neighborhoods with greater exposure to hazards, like air pollution, which may increase the prevalence and severity of chronic diseases. These disparities in neighborhood and home environments and resources could make it more challenging for Black patients to recover at home and attend postoperative clinical visits.

Previous research has also shown how neighborhood environments and resources are social determinants of health that can contribute to racial health disparities. Additionally, a correlation exists between neighborhood built environment and HOLC grades used in redlining.

"These differences in neighborhood, home environment, and community resources may make it more challenging for Black patients, on average, to recover at home and to make postoperative clinical visits," the UCLA researchers reported. "Our finding that Black men experience a higher surgical mortality compared with other subgroups of race and sex is troubling and is also seen with shorter life expectancy among Black men more generally."