Association Between Race and Postoperative Outcomes in a Universally Insured Population Versus Patients in the State of California

Andrew J. Schoenfeld, Wei Jiang, Mitchel B. Harris, Zara Cooper, Tracey Koehlmoos, Peter A. Learn, Joel S. Weissman, Adil H. Haider

Research output: Contribution to journalArticle

Abstract

OBJECTIVE:: To compare disparities in postoperative outcomes for African Americans after surgical intervention in the universally insured military system, versus the civilian setting in California. BACKGROUND:: Health reform proponents cite the reduction of disparities for African Americans and minorities as an expected benefit. The impact of universal health insurance on reducing surgical disparities for African Americans has not previously been examined. METHODS:: We used Department of Defense health insurance (Tricare) data (2006–2010) to measure outcomes for African Americans as compared with Whites after 12 major surgical procedures across multiple specialties. The experience of African Americans in the Tricare system was compared with a similar cohort undergoing surgery in the state of California using the State Inpatient Database (2007–2011). RESULTS:: No significant difference in postoperative complications [odds ratio (OR) 0.91; 95% confidence interval (CI) 0.81, 1.03] or mortality (OR 0.98; 95% CI 0.43, 2.25) were encountered between African Americans and Whites receiving surgery at hospitals administered by the Department of Defense. African Americans in California who were uninsured or on Medicaid had significantly increased odds of mortality (OR 4.76; 95% CI 2.82, 8.05), complications (OR 1.67; 95% CI 1.34, 2.08), failure to rescue (OR 2.72; 95% CI 1.25, 5.94), and readmission (OR 1.78; 95% CI 1.45, 2.19). CONCLUSIONS:: In the equal access military healthcare system, African Americans have outcomes similar to Whites. Disparities were evident in California, especially among those without private insurance. These facts point toward the potential benefits of a federally administered system in which all patients are treated uniformly.

Original languageEnglish (US)
JournalAnnals of Surgery
DOIs
StateAccepted/In press - Aug 5 2016
Externally publishedYes

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African Americans
Odds Ratio
Confidence Intervals
Population
Health Insurance
Mortality
Hospital Departments
Medicaid
Insurance
Inpatients
Outcome Assessment (Health Care)
Databases
Delivery of Health Care
Health

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Schoenfeld, A. J., Jiang, W., Harris, M. B., Cooper, Z., Koehlmoos, T., Learn, P. A., ... Haider, A. H. (Accepted/In press). Association Between Race and Postoperative Outcomes in a Universally Insured Population Versus Patients in the State of California. Annals of Surgery. https://doi.org/10.1097/SLA.0000000000001958

Association Between Race and Postoperative Outcomes in a Universally Insured Population Versus Patients in the State of California. / Schoenfeld, Andrew J.; Jiang, Wei; Harris, Mitchel B.; Cooper, Zara; Koehlmoos, Tracey; Learn, Peter A.; Weissman, Joel S.; Haider, Adil H.

In: Annals of Surgery, 05.08.2016.

Research output: Contribution to journalArticle

Schoenfeld, Andrew J. ; Jiang, Wei ; Harris, Mitchel B. ; Cooper, Zara ; Koehlmoos, Tracey ; Learn, Peter A. ; Weissman, Joel S. ; Haider, Adil H. / Association Between Race and Postoperative Outcomes in a Universally Insured Population Versus Patients in the State of California. In: Annals of Surgery. 2016.
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