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Enumah ZO, Etchill EW, Kim BS, Giuliano KA, Kalra A, Cho SM, Whitman GJR, Ha JS, Choi CW, Higgins RSD, Bush EL. Racial disparities among patients on venovenous extracorporeal membrane oxygenation in the pre-Coronavirus Disease 2019 and Coronavirus Disease 2019 eras: A retrospective registry review. JTCVS OPEN 2024; 17:162-171. [PMID: 38420563 PMCID: PMC10897667 DOI: 10.1016/j.xjon.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/06/2023] [Accepted: 12/10/2023] [Indexed: 03/02/2024]
Abstract
Objectives Although many studies have addressed such disparities caused by COVID-19, to our knowledge, no study has focused on the association of race on outcomes for patients with COVID-19 requiring venovenous extracorporeal membrane oxygenation support. The goal of this study was to assess association of race on death and duration on venovenous extracorporeal membrane oxygenation in both the pre-COVID-19 and COVID-19 eras. Methods We retrospectively reviewed the Extracorporeal Life Support Organization registry and included adults (≥18 years) who required venovenous extracorporeal membrane oxygenation between January 2019 and April 2021. We performed descriptive statistics and multivariable logistic regression. Our primary outcomes were death and extracorporeal membrane oxygenation duration. Results A total of 7477 patients were included after excluding 340 patients (4.3%) who were missing race data. In the COVID-19 era, 1474 of 2777 COVID-19-positive patients (53.1%) died. Our regression model suggested somewhat of a protective effect on death for Black and multiple race patients. Additionally, a diagnosis of COVID-19 and patients in the COVID-19 era in general, irrespective of COVID-19 diagnosis, had higher odds of death. Hispanic patients had the longest average venovenous extracorporeal membrane oxygenation run times. Conclusions Our study using data from the international Extracorporeal Life Support Organization Registry provides updated data on patients supported with venovenous extracorporeal membrane oxygenation in the pre-COVID-19 and COVID-19 eras between 2019 and 2021 with a focus on race. Patients in the COVID-19 era group also had higher mortality compared with those in the pre-COVID-19 era even after being adjusted for COVID-19 diagnosis. Black and multiple races appeared somewhat protective in terms of death. Hispanic race was associated with longer venovenous extracorporeal membrane oxygenation duration.
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Affiliation(s)
| | - Eric W Etchill
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
| | - Bo Soo Kim
- Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Md
| | | | - Andrew Kalra
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Sung-Min Cho
- Neurocritical Care, Johns Hopkins Hospital, Baltimore, Md
| | | | - Jinny S Ha
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
| | - Chun Woo Choi
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
| | | | - Errol L Bush
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Md
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Dahle G. Disparity issues in coronary artery surgery. Curr Opin Cardiol 2023; 38:478-483. [PMID: 37556404 DOI: 10.1097/hco.0000000000001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE OF REVIEW Coronary artery disease is the third leading cause of mortality worldwide. Coronary artery surgery is an important treatment option. Certain groups such as people of color, those from lower socioeconomic backgrounds and women tend to have lower rates of receiving the surgery they need ( Fig. 1 ). RECENT FINDINGS Still there are disparities in treatment options for coronary artery disease among different groups, due to geographic location, economical situation, institutional tradition and sex. SUMMARY Through continued research, awareness and utilization of innovative technologies, we can improve access and equity in healthcare for all patients, including patients in need of coronary surgery.
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Affiliation(s)
- Gry Dahle
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
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3
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Kulkarni A, Arafat M, Hou L, Liang S, Kassotis J. Racial Disparity Among Patients Undergoing Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Replacement in the United States. Angiology 2023; 74:812-821. [PMID: 36426842 DOI: 10.1177/00033197221137025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive alternative to surgical aortic valve replacement (SAVR). However, racial disparities in the utilization of TAVR persist. This meta-analysis attempts to determine whether the prevalence of adverse outcomes (procedure-related complications) represent barriers to the use of TAVR among African Americans (AA). The TAVR cohort consisted of 89.6% Caucasian (C) and 4.7% AA, while the SAVR cohort included 86.9% C and 6.4% AA. The utilization rate (UR) of TAVR was 1.48 and .35 among C and AA, respectively, while the UR of SAVR was 1.44 and .48 among C and AA, respectively. Following TAVR, for AA the odds ratio (OR) was greater for stroke (OR = 1.22, P = .02) and transient ischemic attack (TIA) (OR = 1.57, P < .001) and lower for undergoing the insertion of a permanent pacemaker (OR = .81, P < .001). While there was a significant difference between C and AA in TAVR and SAVR utilization, outcomes between groups following TAVR are comparable; therefore, adverse outcomes do not appear to be a barrier to the use of TAVR among eligible AA.
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Affiliation(s)
- Abha Kulkarni
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Mohammod Arafat
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Linle Hou
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Shiochee Liang
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - John Kassotis
- Department of Cardiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Chen J, Khazanchi R, Bearman G, Marcelin JR. Racial/Ethnic Inequities in Healthcare-associated Infections Under the Shadow of Structural Racism: Narrative Review and Call to Action. Curr Infect Dis Rep 2021; 23:17. [PMID: 34466126 PMCID: PMC8390539 DOI: 10.1007/s11908-021-00758-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
Purpose of Review The purpose of this study is to review racial and ethnic inequities in the incidence and prevention of healthcare-associated infections (HAIs) in the USA, identify gaps in the literature, and recommend future directions to mitigate these inequities. Recent Findings While some existing literature has identified the presence of racial/ethnic inequities in HAI incidence and outcomes, few studies to date have evaluated whether HAI prevention efforts have mitigated these inequities. Factors contributing to inequities in HAI prevention may include unconscious bias of healthcare professionals towards minoritized patients; socioeconomic and structural inequities disparately affecting minoritized communities; the racial segregation of quality healthcare through hospital price discrimination; divergent reimbursement rates between public and private insurers; policies or performance metrics which underfund and financially penalize safety-net hospitals; and insufficient research evaluating and addressing HAI inequities. Summary Expansion of the literature is needed to further interrogate root causes and evaluate the impact of interventions on racial/ethnic inequities in HAI incidence. Measures to mitigate inequities might include teaching healthcare workers how to recognize and mitigate unconscious biases, expanding community resources which address the social and structural determinants of health, increasing access to preventive health services, reforming federal and institutional policies to better support safety-net hospitals and disincentivize price discrimination, and improving diversity and inclusion within the health workforce.
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Affiliation(s)
- Jiabi Chen
- School of Medicine, Virginia Commonwealth University, Richmond, VA USA
| | - Rohan Khazanchi
- College of Medicine, University of Nebraska Medical Center, Omaha, NE USA.,School of Public Health, University of Minnesota, Minneapolis, MN USA
| | - Gonzalo Bearman
- Department of Internal Medicine, Division of Infectious Disease, Virginia Commonwealth University, Richmond, VA USA
| | - Jasmine R Marcelin
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE USA
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Rosenblum JM, Binongo J, Wei J, Liu Y, Leshnower BG, Chen EP, Miller JS, Macheers SK, Lattouf OM, Guyton RA, Thourani VH, Halkos ME, Keeling WB. Priorities in coronary artery bypass grafting: Is midterm survival more dependent on completeness of revascularization or multiple arterial grafts? J Thorac Cardiovasc Surg 2021; 161:2070-2078.e6. [DOI: 10.1016/j.jtcvs.2019.11.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/15/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022]
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Enumah ZO, Canner JK, Alejo D, Warren DS, Zhou X, Yenokyan G, Matthew T, Lawton JS, Higgins RSD. Persistent Racial and Sex Disparities in Outcomes After Coronary Artery Bypass Surgery: A Retrospective Clinical Registry Review in the Drug-eluting Stent Era. Ann Surg 2020; 272:660-667. [PMID: 32932322 PMCID: PMC8491278 DOI: 10.1097/sla.0000000000004335] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the temporal trends in 30-day mortality by race group for patients undergoing coronary artery bypass grafting (CABG) between 2011 and 2018 and to investigate the effect of race and sex on postoperative outcomes after CABG. SUMMARY BACKGROUND DATA Cardiovascular diseases remain a leading cause of death in the United States with studies demonstrating increased morbidity and mortality for black and female patients undergoing surgery. In the post drug-eluting stent era, studies of racial disparities CABG are outdated. METHODS We performed a retrospective analysis of the Society for Thoracic Surgeons database for patients undergoing CABG between 2011 and 2018. Primary outcome was 30-day mortality. Secondary outcomes included postoperative length of stay, surgical site infection, sepsis, pneumonia, stroke, reoperation, reintervention, early extubation, and readmission. RESULTS The study population was comprised of 1,042,506 patients who underwent isolated CABG between 2011 and 2018. Among all races, Black patients had higher rates of preoperative comorbidities. Compared with White patients, Black patients had higher overall mortality (2.76% vs 2.19%, P < 0.001). On univariable regression, Black patients had higher rates of death, infection, pneumonia, and postoperative stroke compared to White patients. On multivariable regression, Black patients had higher odds of 30-day mortality compared to white patients [odds ratio (OR) = 1.11, 95% confidence interval (CI) 1.05-1.18]. Similarly, female patients had higher odds of death compared to males (OR = 1.26, 95% CI 1.21-1.30). CONCLUSIONS In the modern era, racial and sex disparities in mortality and postoperative morbidity after coronary bypass surgery persist with Black patients and female patients consistently experiencing worse outcomes than White male patients. Although there may be unknown or underappreciated biological mechanisms at play, future research should focus on socioeconomic, cultural, and multilevel factors.
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Affiliation(s)
| | - Joseph K. Canner
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD
| | - Diane Alejo
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD
| | - Daniel S. Warren
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD
| | - Xun Zhou
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD
| | - Gayane Yenokyan
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD
| | - Thomas Matthew
- Johns Hopkins Suburban Hospital, Department of Cardiac Surgery, Bethesda, MD
| | - Jennifer S. Lawton
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD
| | - Robert S. D. Higgins
- Johns Hopkins University School of Medicine, Department of Surgery, Baltimore, MD
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Are racial differences in hospital mortality after coronary artery bypass graft surgery real? A risk-adjusted meta-analysis. J Thorac Cardiovasc Surg 2019; 157:2216-2225.e4. [DOI: 10.1016/j.jtcvs.2018.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/12/2018] [Accepted: 12/02/2018] [Indexed: 01/13/2023]
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Anderson E, Glogoza M, Bettenhausen A, Guenther R, Dangerfield D, Jansen R, Newman R, Warne D, Dyke C. Disparities in Cardiovascular Risk Factors in Northern Plains American Indians Undergoing Coronary Artery Bypass Grafting. Health Equity 2018; 2:152-160. [PMID: 30283862 PMCID: PMC6110186 DOI: 10.1089/heq.2018.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: Heart disease is the leading cause of death in American Indians (AIs). For AI patients with severe coronary artery disease requiring coronary artery bypass graft (CABG) surgery, little data exist. The purpose of this study was to evaluate short-term outcomes of Northern Plains AI undergoing CABG and identify variations in patient presentation. Methods: All patients undergoing isolated CABG between June 2012 and June 2017 were studied. Seventy-four AI and 1236 non-American Indian (non-AI) patients were identified. Risk factors, preoperative characteristics, cardiac status, procedural information, and outcomes were collected. Univariate analysis comparing short-term clinical outcomes between AI and non-AI populations was performed. Multivariable logistic regression models were constructed and outcome differences assessed. Unadjusted Kaplan-Meier survival estimates were produced using 5-year survival data. Results: AI patients presented with increased risk factors, including higher rates of diabetes mellitus (AI 63.5% vs. non-AI 38.7% p=< 0.001) and smoking/tobacco use (AI 60.8% vs. non-AI 20.0% p=> 0.001). Seventy-nine percent of AI patients resided on or near federal reservations and presented from rural locations. Internal mammary artery (IMA) graft use in both groups was high (AI 95.9% vs. non-AI 94.9% p=0.904), and multiarterial grafting with left internal mammary artery and radial artery use was common in both groups (AI 67.6% vs. non-AI 69.6% p=0.814). No significant differences in unadjusted 30-day mortality or short-term outcomes were detected. Adjusted Kaplan-Meier survival curves were similar between race groups up through 5 years after CABG (p-value=0.38). Conclusion: AIs presented with significantly more risk factors for cardiovascular disease compared with the general population, with especially high rates of insulin-dependent diabetes and active tobacco use. Despite this, outcomes were similar between groups. In propensity-matched groups, AIs were at decreased risk for prolonged length of stay and combined morbidity/mortality. In contrast to previous reports, AI racial identity did not adversely affect survival up to 5 years after CABG.
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Affiliation(s)
- Eric Anderson
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Matthew Glogoza
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Aaron Bettenhausen
- Department of Cardiothoracic Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Rory Guenther
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Dylan Dangerfield
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - Rick Jansen
- Department of Public Health, North Dakota State University, Fargo, North Dakota
| | - Roxanne Newman
- Department of Cardiothoracic Surgery, Sanford Health Fargo, Fargo, North Dakota
| | - Donald Warne
- Department of Public Health, North Dakota State University, Fargo, North Dakota
| | - Cornelius Dyke
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
- Department of Cardiothoracic Surgery, Sanford Health Fargo, Fargo, North Dakota
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