title: Awareness of racial/ethnic disparities in surgical outcomes and care: factors affecting acknowledgment and action.
abstract: BACKGROUND
  Studies have demonstrated racial/ethnic disparities in surgical outcomes and care. Surgeon awareness and its association with institutional action remain unclear. The study sought to assess surgeons' awareness of racial/ethnic disparities, ascertain whether demographic and practice factors influence acknowledgement of disparities, and determine whether surgeons are seeking to mitigate disparities.
  
  
  METHODS
  Anonymous online survey was administered to a random sample of American College of Surgeons (ACS) general surgeons (July 2013 to March 2014). Responses were weighted for nonresponse and risk-adjusted using logistic regression.
  
  
  RESULTS
  172 surgeons completed the survey. Levels of acknowledged disparities were low. Less than one half reported institutional efforts to address disparities, and less than one fourth had taken efforts to investigate disparities in their personal practice. Several respondent factors including Academic Medical Center affiliation, awareness of the ACS statement on optimal access, and year of medical school graduation significantly associated with expressed acknowledgment of disparities.
  
  
  CONCLUSIONS
  Such associations speak to the need for continued efforts to promote enhanced provider awareness and participation. As the field of surgical disparities moves from understanding to action, we must acknowledge the contributing role that providers play.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Breanne V
authors.initials: BV
authors.lastname: Britton
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Neeraja
authors.initials: N
authors.lastname: Nagarajan
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, and the Department of Surgery, Brigham and Women's Hospital, Boston, MA 02120, USA.
authors.forename: Cheryl K
authors.initials: CK
authors.lastname: Zogg
authors.affiliation: International Center for Spinal Cord Injury, The Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Shalini
authors.initials: S
authors.lastname: Selvarajah
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Schupper
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: A Gatebe
authors.initials: AG
authors.lastname: Kironji
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Albert T
authors.initials: AT
authors.lastname: Lwin
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cerullo
authors.affiliation: Division of Trauma, Burns, and Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.affiliation: Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, and the Department of Surgery, Brigham and Women's Hospital, Boston, MA 02120, USA. Electronic address: ckzogg@gmail.com.
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D001291:Attitude of Health Personnel; D001364:Awareness; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D044469:Racial Groups / Q000208:ethnology / Q000706:statistics & numerical data; D018570:Risk Assessment; D066231:Surgeons / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative / Q000379:methods / Q000639:trends; D011795:Surveys and Questionnaires; D014481:United States
keywords: Disparities; Intervention; Optimal access; Provider awareness; Surgical disparities