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

Schoenfeld, Andrew J. MD, MSc*; Jiang, Wei MS; Harris, Mitchel B. MD, FACS*; Cooper, Zara MD, MSc; Koehlmoos, Tracey PhD; Learn, Peter A. MD, FACS§; Weissman, Joel S. PhD; Haider, Adil H. MD, MPH, FACS

doi: 10.1097/SLA.0000000000001958
Original Articles

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.

*Center for Surgery and Public Health, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD

§Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.

Reprints: Andrew J. Schoenfeld, MD, MSc, Center for Surgery and Public Health, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115. E-mail: ajschoen@neomed.edu.

Funding disclosure: This research was supported by a grant from the Henry M. Jackson Foundation of the Department of Defense (DoD) to AJS, WJ, TK, and AHH. The DoD was not involved in the design, analyses or interpretation of results. The findings and views expressed here are those of the authors and should not be viewed as representative of the DoD or the United States Government.

There are no conflicts of interest to report.

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