Blacks With Diverticulitis Have Worse Outcomes

NEW YORK (Reuters Health) – Blacks need emergency surgery more often than whites for a common type of intestinal disease, and they tend to fare worse afterwards, suggests a study of older Americans on Medicare.

It’s not the first time researchers find racial differences in rates of complications and death from the disease, called diverticulitis. But those disparities have been blamed on lack of health insurance and access to care among blacks.

The new study hints there may be cultural differences or treatment disparities between races that explain why blacks are more likely to die or be sent back to the hospital after treatment, even when they have health insurance.

For example, blacks seem to be less likely to see a primary care doctor regularly, experts said, or may be treated in more-crowded, poorly-funded hospitals.

“You’re left with this very disturbing finding that the treatment of blacks and whites in the United States remains disparate,” said Dr. Selwyn Rogers, Jr., who studies inequalities in surgical care at Harvard Medical School in Boston but wasn’t involved in the new work. “You’re more likely to die if you happen to be black,” he told Reuters Health.

In diverticulitis, pouches in the intestine become infected or inflamed. The condition may affect up to one in four elderly Americans at some point, researchers wrote in the Archives of Surgery, and can be dangerous when not caught early. It causes severe stomach pain and sometimes nausea and vomiting.

The study, led by Eric Schneider from The Johns Hopkins School of Medicine in Baltimore, included more than 50,000 patients who were treated for diverticulitis, either with emergency or elective surgery, between 2004 and 2007. All of them were at least 65 years old and covered by Medicare, the government health insurance for the elderly.

More than two-thirds of the procedures done in blacks were emergency surgeries, compared to about 55 percent of those in white patients. Blacks were more likely to die in the hospital than whites: Close to seven percent of them didn’t survive their stay, versus five percent of white patients.

That difference persisted when the researchers looked only at people who were admitted for emergency care, and when they took into account pre-existing medical conditions, such as heart failure and diabetes. Death rates were one or two percent in both blacks and whites who had elective surgery before their symptoms were severe, but rose to up to nine percent in blacks getting emergency surgery.

On average, black diverticulitis patients also had longer and more expensive hospital stays, and they were more likely to be readmitted to the hospital within a month of their surgery. Even when they do have insurance, blacks may wait longer to see a doctor if they’re having stomach symptoms, or might have less accessible places to get treated, according to researchers who spoke with Reuters Health.

They may also have worse general health that wasn’t reflected in the data Schneider and his colleagues were using. Another explanation may be in the type of care patients receive — for example, blacks may be more likely to be treated at hospitals that are smaller and not as well-staffed, the researchers wrote.

“Some of these observed differences despite Medicare coverage reflect the hospitals in which patients receive care,” agreed Rogers. “A patient can walk in with Medicare coverage, but if those hospitals are struggling (financially), that’s going to be reflected in the services they can provide,” he told Reuters Health.

He pointed to the effect of poverty and lack of education on health and disease outcomes, adding that “every time we turn over a rock” there are disparities by race, ethnicity and income. Schneider’s team called for further studies to tease out the reasons why blacks with diverticulitis specifically tend to have worse outcomes than whites, even when they’re both covered by insurance.

For now, he emphasized that having regular primary care visits and being aware of anything that’s not quite right are key to preventing the worst. “The one thing that’s clear, regardless of who you are, seeking treatment early is better than waiting,” he told Reuters Health.

“If you were being followed on a regular basis and it was determined you needed to have this surgery and it was done (electively), that’s a much better way to go.”

SOURCE: http://bit.ly/vhUek3 Archives of Surgery, online November 21, 2011.

Reuters Health