Racial disparities in Medicaid patients after brain tumor surgery.
The presence of healthcare-related disparities is an ongoing, widespread, and well-documented societal and health policy issue. We investigated the presence of racial disparities among post-operative patients either with meningioma or malignant, benign, or metastatic brain tumors. We used the Medicaid component of the Thomson Reuter's MarketScan database from 2000 to 2009. Univariate and multivariate analysis assessed death, 30-day post-operative risk of complications, length of stay, and total charges. We identified 2321 patients, 73.7% were Caucasian, 57.8% were women; with Charlson comorbidity scores of <3 (56.2%) and treated at low-volume centers (73.4%). Among all, 26.3% of patients were of African-American ethnicity and 22.1% had meningiomas. Mortality was 2.0%, mean length of stay (LOS) was 9 days, mean total charges were US$42,422, an adverse discharge occurred in 22.5% of patients, and overall 30-day complication rate was 23.4%. In a multivariate analysis, African-American patients with meningiomas had higher odds of developing a 30-day complication (p=0.05) and were significantly more likely to have longer LOS (p<0.001) and greater total charges (p<0.001) relative to Caucasian counterparts. The presence of one post-operative complication doubled LOS and nearly doubled total charges, while the presence of two post-operative complications tripled these outcomes. Patients of African-American ethnicity had significantly higher post-operative complications than those of Caucasian ethnicity. This higher rate of complications seems to have driven greater healthcare utilization, including greater LOS and total charges, among African-American patients. Interventions aimed at reducing complications among African-American patients with brain tumor may help reduce post-operative disparities.
Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. debraj.mukherjee@cshs.org
Debraj
D
Mukherjee
Chirag G
CG
Patil
Nathan
N
Todnem
Beatrice
B
Ugiliweneza
Miriam
M
Nuño
Michael
M
Kinsman
Shivanand P
SP
Lad
Maxwell
M
Boakye
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001932:Brain Neoplasms / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D003399:Craniotomy / Q000191:economics / Q000379:methods; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D038801:International Classification of Diseases; D007902:Length of Stay; D008297:Male; D008484:Medicaid / Q000191:economics*; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014481:United States; D044465:White People