Minority children are more likely than white children to die after surgery in the US, irrespective of their socioeconomic status (SES), according to new research. The first-of-its-kind study is being presented at the ANESTHESIOLOGY® 2021 annual meeting in San Diego, this week.
Racial disparities in the healthcare system are rife, a fact that the ongoing COVID-19 pandemic has served to highlight. Research has found that people of Asian or Black ethnic origin are at a higher risk of death associated with the virus, while the decline in US life expectancy that ensued was disproportionate among ethnic minorities. On average, Black Americans lost 3.25 years of life, almost twice that suffered by the average US citizen, and Hispanic Americans lost even more. The inequalities in the system are, sadly, no different in children. Last year, a study found that Black children are almost 3.5 times more likely to die after common surgeries than white children, even when apparently healthy.
Generally assumed to be a symptom of socioeconomic status (SES) discrepancies, the new study demonstrates that this appears not to be the case.
“Given that minority children — especially Black and Hispanic children — are more likely to be born into poverty than white children, the common narrative is that the difference in SES is a primary reason for the racial disparity in the rate of post-surgical death,” Dr Brittany L. Willer, M.D., lead author and pediatric anesthesiologist at Nationwide Children’s Hospital, Columbus, Ohio, said in a statement.
“Though white children belonging to families of higher SES benefit from improved health outcomes in comparison to their peers in lower SES families, this study demonstrates that a ‘wealth advantage’ does not exist for minority children.”
The study used the median household income of each child’s specific ZIP code to determine their SES. Minority children in the lowest-income quartile had a greater risk of death post-surgery than those in the highest-income quartile, but the difference was not statistically significant, leading the authors to conclude that SES does not confer an advantage when it comes to postoperative mortality in minority groups.
The results are even more stark when compared against those of white children. Minority children were more likely to die after surgery than white children from the same socioeconomic background. Black children in the lowest three income quartiles, for example, were 1.5 times more likely to die post-operation than white children in the lowest three income quartiles.
The data on post-surgical deaths comes from the national Kids’ Inpatient Database for 2006, 2009, and 2012. The same number of white children were compared with each of the minority groups, in a 1:1 ratio – 79,280 Black children, 5,344 Native American children, 17,508 Asian children, and 116,125 Hispanic children’s surgical outcomes were analyzed alongside the corresponding number of white children’s.
Dr Willer notes that the same patterns the study demonstrates in children are seen in adults – health outcomes in minority adults also do not improve for those with higher SES, indicating the limitations of upward mobility for minorities. Systemic racial inequalities and prejudice are perhaps at the root of the study’s findings. Known to contribute to increased rates of depression, obesity, and chronic stress in minority groups of all socioeconomic backgrounds, inequity and racism in the health care system, as well as in life, can have a huge impact on health and mortality. Racism, for example, can be incredibly damaging to those experiencing it, potentially disrupting normal gene expression, and resulting in a predisposition for various conditions, and even a shortened lifespan. Likewise, Black women subjected to racism have been found to experience trauma-like effects, which increases their risk of future health problems.
Socioeconomic factors, such as reduced parental health literacy, hazardous environmental exposures, and poor access to resources, which are all associated with poverty and lower SES quartiles, also need to be addressed, according to Willer.
“Equitable and personalized surgical care should be the ultimate goal for children of all SES classes, races and ethnicities,” she said. “Physician anesthesiologists and surgeons can do a number of things to achieve surgical equity, including following clinical guidelines to reduce disparities, using enhanced recovery after surgery protocols to standardize delivery of perioperative care, and employing race-specific surgical risk models to counsel families whose children are having surgery. Most importantly, we need to be aware of our implicit biases and practice strategies to address them.”