Association Between the COVID-19 Pandemic and Disparities in Access to Major Surgery in the US.
JAMA Netw Open
; 5(5): e2213527, 2022 05 02.
Article
en En
| MEDLINE
| ID: mdl-35604684
ABSTRACT
Importance Racial minority groups account for 70% of excess deaths not related to COVID-19. Understanding the association of the Centers for Medicare & Medicaid Services' (CMS's) moratorium delaying nonessential operations with racial disparities will help shape future pandemic responses. Objective:
To evaluate the association of the CMS's moratorium on elective operations during the first wave of the COVID-19 pandemic among Black individuals, Asian individuals, and individuals of other races compared with White individuals. Design, Setting, andParticipants:
This cross-sectional study assessed a 719-hospital retrospective cohort of 3â¯470â¯905 adult inpatient hospitalizations for major surgery between January 1, 2018, and October 31, 2020. Exposure The first wave of COVID-19 infections between March 1, 2020, and May 31, 2020. Main Outcomes andMeasures:
The main outcome was the association between changes in monthly elective surgical case volumes and the first wave of COVID-19 infections as a function of patient race, evaluated using negative binomial regression analysis.Results:
Among 3â¯470â¯905 adults (1â¯823â¯816 female [52.5%]) with inpatient hospitalizations for major surgery, 70â¯752 (2.0%) were Asian, 453â¯428 (13.1%) were Black, 2â¯696â¯929 (77.7%) were White, and 249â¯796 (7.2%) were individuals of other races. The number of monthly elective cases during the first wave was 49% (incident rate ratio [IRR], 0.49; 95% CI, 0.486-0.492; P < .001) compared with the baseline period. The relative reduction in unadjusted elective surgery cases for Black (unadjusted IRR, 0.99; 95% CI, 0.97-1.01; P = .36), Asian (unadjusted IRR, 1.08; 95% CI, 1.03-1.14; P = .001), and other race individuals (unadjusted IRR, 0.97; 95% CI, 0.95-1.00; P = .05) during the surge period compared with the baseline period was very close to the change in cases for White individuals. After adjustment for age, sex, comorbidities, and surgical procedure, there was still no evidence that the first wave of the pandemic was associated with disparities in access to elective surgery. Conclusions and Relevance In this cross-sectional study, the CMS's moratorium on nonessential operations was associated with a 51% reduction in elective operations. It was not associated with greater reductions in operations for racial minority individuals than for White individuals. This evidence suggests that the early response to the pandemic did not increase disparities in access to surgical care.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
COVID-19
Tipo de estudio:
Observational_studies
/
Prevalence_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Female
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Humans
País/Región como asunto:
America do norte
Idioma:
En
Revista:
JAMA Netw Open
Año:
2022
Tipo del documento:
Article