The discovery is unprecedented. Although it has already been proven that African Americans experience more postoperative complications than white Americans (due to more common co-morbidities, such as diabetes, obesity or cardiovascular disease), the fact that these disparities can exist between healthy children, without chronic disease or other risk factors, had not yet been observed.
The NSQIP-P allowed researchers to examine a sample of 172,549 healthy children
The research team from the National Children’s Hospital of Columbus, Ohio, found in a study that African American children were 3.43 times more likely to die within 30 days surgery than white children. “Our hypothesis was that the rates of complications and / or mortality among healthy children would not fluctuate according to racial category. But our results show that if ”, says Olubukola Nafiu, pediatric anesthetist and lead author of the study, in a press release.
Researchers detail their mode of operation in an article in the medical journal Pediatrics published Monday July 20. The study was carried out by analyzing the database, for the period from 2012 to 2017, of the National Program for the Improvement of Surgical Quality in Pediatrics (National Surgical Quality Improvement Program-Pediatric – NSQIP-P) offered by the American College of Surgeons, an association of surgeons. The NSQIP-P collects data from 186 medical centers across the United States, and allowed researchers to examine a sample of 172,549 healthy children.
Variables to take into account
The study found that even in healthy patients postoperative complications and mortality rates were higher for blacks than for whites. The difference between the two populations cannot therefore be reduced to preoperative comorbidities.
If this data processing highlights a glaring difference between white and black children, it has limits, since it does not concretely explain the reason. To achieve this, researchers lack valuable information, such as the type of hospital that receives patients: “We were unable to take into account where these patients were operated on, although other researchers have proven that minority patients received poorer quality care., writes the research team. Unfortunately, the NSQIP-P program strongly discourages attempts to identify specific hospitals in the database. “
In 2018, 11% of the black population (excluding the elderly) did not have health insurance due to lack of funds
Doctors add to this the risk that the children in their sample were treated in only a handful of hospitals, because postoperative complications remain rare for young patients. They fear that the results are therefore not representative of a situation existing throughout the territory. Finally, Olubukola Nafui and her colleagues did not have information on the status of patients with regard to social security, which can be an important socio-economic indicator in the United States (in 2018, 11% of the black population, excluding people elderly, did not have health insurance due to lack of funds (and only 55.4% had private insurance, against 74.8% of the white population).
The researchers point out that it is raw data that made it possible to reveal these results, and that the gap between black and white children is a simple observation. For Olubokola Nafui and his team, “The next task is to examine which postoperative complications are causing the observed morbidity and mortality rate in order to identify results that may vary.”
Known racial inequalities in the health sector
The results of this study, even if it has its limits, allow us to re-emphasize a phenomenon already identified for a long time: inequalities between whites and blacks also exist in the health sector in the United States. The association White Coats for Black Lives (“White coats for black lives”), created in 2015 and mobilized during the recent demonstrations of the Black Lives Matter movement, in June, affirms that “Racism is a public health problem”.
African Americans also face discrimination caused by racist prejudice
African Americans face more difficulties in accessing healthcare. In addition to the cost of health insurance, they face discrimination caused by racist prejudice, conscious or unconscious, on the part of the medical profession. These preconceptions have negative consequences on their management by health personnel. A study published in 2016, and conducted on 222 medical students, revealed that a third of them believed, for example, that black skin is thicker than white skin, which can have direct consequences, in particular on their pain management and their empathy for patients.
Even the algorithms are unfavorable. This is the case with decision support software often used by hospitals, health organizations and insurance firms, which enables the assessment of people in need of care in the years to come. During their research, a team of scientists realized that the algorithm they used assigned the same score to sick black people and white people with less worrying health.
