Hispanic Patients Receive Fewer Surgical Interventions and Less Favorable Outcomes for Treatment of Vascular Disease
Reasons for Disparities May Include Socioeconomic Factors and Genetic Variations<br><br>Surgeries in New York State and Florida Studied by Researchers at NewYork-Presbyterian Hospital, Columbia University Medical Center and Weill Cornell Medical College
Nov 9, 2007
Hispanics in the United States receive fewer vascular surgeries than the general population and have worse outcomes in some cases, according to new research, which also finds that Hispanics often seek treatment only after developing more advanced disease. Reasons for the disparities are not fully understood, but may include a combination of socioeconomic factors and genetic variations.
Published in the November Journal of Vascular Surgery, the study was led by a vascular surgery team from NewYork-Presbyterian Hospital, Columbia University Medical Center and Weill Cornell Medical College.
Using medical records from hospitals in New York and Florida from the years 2000 to 2004, researchers looked at three common vascular surgery procedures—lower extremity revascularization (LER), carotid revascularization (CR), and abdominal aortic aneurysm (AAA) repair.
They found that Hispanic patients, compared to non-Hispanic whites, had higher rates of amputation following lower extremity revascularization (a surgical procedure to restore blood supply to a body part or organ) (6.2% vs. 3.4%) and greater risk for death following elective AAA repair (5.0% v. 3.4%). Additionally, Hispanic patients were as much as two times more likely than whites to seek treatment only after developing more advanced disease. They also spend more time in the hospital recovering.
"These are significant disparities, and the reasons for them must be determined in order to make improvements," says the study's principal investigator, Dr. Nicholas J. Morrissey, director of clinical trials and a vascular surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center and assistant professor of surgery at Columbia University College of Physicians and Surgeons and Weill Cornell Medical College. "One explanation may be socioeconomic factors, particularly insurance status, which could impede Hispanic patients' access to proper preventive and diagnostic care."
In addition, the study notes that Hispanics traditionally rely on self-care methods and are reluctant to seek professional treatment, and may even be less "willing" to consider prophylactic surgical interventions. It is also possible that there are genetic differences in the nature and manifestation of vascular disease.
Consistent with previous studies, the study also found elevated rates of diabetes, renal failure and hypertension among Hispanic patients. According to the authors, efforts directed at detection and control of these conditions would be an important component of a strategy aimed at addressing vascular disease for this population. However, they note that Hispanic ethnicity remained associated with more advanced disease even after controlling for coexisting co-morbidities, including diabetes—a fact that points toward other explanations.
"The Hispanic population represents the fastest growing minority in the United States. As the population grows and ages, the vascular surgery community will be providing increasing amounts of care to this diverse group," Dr. Morrissey says.
Previous research cited by the study shows that ethnicity and race are predictors of screening disparities, treatment variations and health outcomes. Racial differences in utilization of surgical procedures have been seen in a wide variety of procedures—including joint replacements, myocardial revascularization, renal transplant and even dialysis access. Among a variety of explanations are genetic variations, lack of screening, inferior access to care and awareness, delayed intervention and treatment discrepancies. Research has shown that these differences did not lessen significantly during the 1990s.
Additional co-authors from Weill Cornell Medical College and Columbia University College of Physicians and Surgeons—affiliates of NewYork-Presbyterian Hospital—include senior author Dr. K. Craig Kent, Dr. Jeannine K. Giacovelli, Natalia Egorova, Dr. Annetine Gelijns, Dr. Alan Moskowitz and Dr. James McKinsey; and, from Columbia University Medical Center's International Center for Health Outcomes and Innovation Research, Dr. Giampaolo Greco, Dr. Annetine Gelijns, Dr. Alan Moskowitz and Natalia Egorova.
NewYork-Presbyterian Hospital—based in New York City—is the nation's largest not-for-profit, non-sectarian hospital, with 2,242 beds. It provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, Morgan Stanley Children's Hospital of NewYork-Presbyterian, NewYork-Presbyterian Hospital/Allen Pavilion and NewYork-Presbyterian Hospital/Westchester Division. One of the largest and most comprehensive health-care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. It ranks sixth in U.S.News & World Report's guide to "America's Best Hospitals," ranks first on New York magazine's "Best Hospitals" survey, has the greatest number of physicians listed in New York magazine's "Best Doctors" issue, and is included among Solucient's top 15 major teaching hospitals. The Hospital is ranked with among the lowest mortality rates for heart attack and heart failure in the country, according to a 2007 U.S. Department of Health and Human Services (HHS) report card. The Hospital has academic affiliations with two of the nation's leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons.
Weill Cornell Medical College
Weill Cornell Medical College—Cornell University's Medical School located in New York City—is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Weill Cornell, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in such areas as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular medicine, AIDS, obesity, cancer, psychiatry and public health—and continue to delve ever deeper into the molecular basis of disease in an effort to unlock the mysteries behind the human body and the malfunctions that result in serious medical disorders. The Medical College—in its commitment to global health and education—has a strong presence in such places as Qatar, Tanzania, Haiti, Brazil, Germany and Turkey. With the historic Weill Cornell Medical College in Qatar, the Medical School is the first in the U.S. to offer its M.D. degree overseas. Weill Cornell is the birthplace of many medical advances—from the development of the Pap test for cervical cancer to the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the world's first clinical trial for gene therapy for Parkinson's disease, and, most recently, the first indication of bone marrow's critical role in tumor growth. For more information, visit www.med.cornell.edu.
Columbia University Medical Center
Columbia University Medical Center provides international leadership in pre-clinical and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, public health professionals, dentists, nurses, and scientists at the College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. For more information, visit www.cumc.columbia.edu.
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