Racial disparities in surgical care and outcomes in the United States: a comprehensive review of patient, provider, and systemic factors
Open accessAbstract
It is well known that there are significant racial disparities in health care outcomes, including surgery. However, the mechanisms that lead to these disparities are still not fully understood. In this comprehensive review of the currently published surgical disparity literature in the United States, we assess racial disparities in outcomes after surgical procedures, focusing on patient, provider, and systemic factors. The PubMed, EMBASE, and Cochrane Library electronic databases were searched with the keywords: healthcare disparities AND surgery AND outcome AND US. Only primary research articles published between April 1990 and December 2011 were included in the study. Studies analyzing surgical patients of all ages and assessing the endpoints of mortality, morbidity, or the likelihood of receiving surgical therapy were included. A total of 88 articles met the inclusion criteria. This evidence-based review was compiled in a systematic manner, relying on retrospective, cross-sectional, case-control, and prospective studies in the absence of Class I studies. The review found that patient factors such as insurance status and socioeconomic status (SES) need to be further explored, as studies indicated only a premature understanding of the relationship between racial disparities and SES. Provider factors such as differences in surgery rates and treatment by low volume or low quality surgeons also appear to play a role in minority outcome disparities. Finally, systemic factors such as access to care, hospital volume, and hospital patient population have been shown to contribute to disparities, with research consistently demonstrating that equal access to care mitigates outcome disparities.
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In some studies, racial and ethnic surgical disparities appear to be driven by unequal social determinants of health such as relative neighborhood deprivation and uninsured or underinsured insurance status.
“In some studies, racial and ethnic surgical disparities appear to be driven by unequal social determinants of health such as relative neighborhood deprivation and uninsured or underinsured insurance status.”
From Racial and ethnic disparities in interhospital transfer for complex emergency general surgical disease across the United States (2023) · cites this paper as [1]
The Insurance section says uninsured or publicly insured patients generally have worse surgical outcomes and that insurance coverage may contribute to racial inequities. The Socioeconomic Status section discusses income and residence-based measures, but does not establish relative neighborhood deprivation as a driver of racial disparities. The Conclusion also cautions that evidence linking socioeconomic status to those disparities is conflicting and that disparities persist after controlling for insurance. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn other studies, surgical disparities persist when controlling for social determinants and insurance variables, suggesting additional unknown mechanisms drive observed disparities.
“In others, surgical disparities persist when controlling for these variables, suggesting that there are additional, unknown mechanisms driving observed disparities that warrant closer examination.”
From Racial and ethnic disparities in interhospital transfer for complex emergency general surgical disease across the United States (2023) · cites this paper as [1]
The Insurance section (page unavailable) says racial surgical outcome disparities persist after controlling for insurance status and gives an adjusted hepatectomy example. The Introduction says the mechanisms remain incompletely understood. But the Conclusion describes evidence on socioeconomic status as conflicting, so the review does not establish that disparities persist after controlling for both insurance and the broader social determinants implied by the claim. (LLM, conf=0.85)
Experimental — accuracy not yet measuredDifferential access to specialty care can drive surgical disparities.
“Differential access to specialty care can drive surgical disparities.”
From Racial and ethnic disparities in interhospital transfer for complex emergency general surgical disease across the United States (2023) · cites this paper as [1]
The selection of covariates was made a priori based on factors known to influence interhospital transfer.
“The selection of covariates was made a priori based on factors known to influence IHT.”
From Racial and ethnic disparities in interhospital transfer for complex emergency general surgical disease across the United States (2023) · cites this paper as [1]
The Hospital volume section discusses factors associated with where patients receive surgical care, but not factors known to influence interhospital transfer. Searches for interhospital-transfer covariates and transfer between hospitals found no passage addressing the claimed basis for a priori covariate selection. The cited review therefore does not verify that statement. (LLM, conf=0.73)
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References 99 · Cited by 593
- Authors
- Haider, A. H., Scott, V. K., Rehman, K. A., Velopulos, C., Bentley, J. M., Cornwell, E. E., & Al-Refaie, W.
- Affiliations
- Johns Hopkins University (US)
- Howard University (US)
- Corresponding author
- Haider, Adil H.
- Venue
- Journal of the American College of Surgeons
- Published
- 2013-03
- Volume
- 216
- Issue
- 3
- Pages
- 482-492e12
- ISSN
- 1072-7515 (ISSN-L)
- PMC
- PMC5995336
- OpenAlex
- W2151080501
- Cited by
- 593
- References
- 99
- Citations by year
- 2026: 46 · 2025: 49 · 2024: 72 · 2023: 74 · 2022: 90 · 2021: 74 · 2020: 50 · 2019: 33 · 2018: 23 · 2017: 26 · 2016: 16 · 2015: 21 · 2014: 13 · 2013: 5
- FWCI
- 20.86
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of the American College of Surgeons (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eCommons - AKU (Aga Khan University) (submittedVersion)
- Funders
- National Institute of General Medical Sciences (K23GM093112)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Gender Studies › Diversity and Career in Medicine
- Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
- Keywords
- racial disparities, surgical outcomes, health care disparities, postoperative mortality, postoperative morbidity, access to surgical care, hospital volume, surgeon volume, socioeconomic status, insurance status, minority patients, patient factors, provider factors, systemic factors
- MeSH terms
- Health Services Accessibility, Humans, Minority Groups, United States, Outcome Assessment, Health Care, Insurance Coverage, Healthcare Disparities
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