* Black patients more likely to select “riskier” emergency diverticulitis surgery over scheduled surgery.
* Surgery selection alone however, does not account for huge difference in mortality rates.
* Researchers trying to pinpoint if black patients wait longer to seek help and/or surgery or if some other issue is causing high mortality rates.
A recent study by Johns Hopkins (published end of November 2011) has uncovered an alarming trend in diverticulitis surgery mortality rates. These researchers analyzed over 50,000 cases of Medicare patients who opted for diverticulitis surgery to see if they could find any discrepancies. What they discovered was a 28% higher mortality rate in African-Americans versus Caucasians! All of these cases involved people undergoing diverticulitis surgery and age, severity of illness, and insurance companies were ruled out as factors. They did notice that African-Americans were over 25% more likely to choose a “riskier” emergency surgery over the traditional scheduled surgery but that one discrepancy did not account for the huge difference in mortality rates between races.
The data prompted the study leader, Eric Schneider (epidemiologist at the Johns Hopkins Center for Surgical Trials and Outcomes Research) to state the following:
“Even if everyone has coverage, black patients are doing worse, so we need to find out what else is going on. Maybe then we can make a difference.”
So what is behind this alarmingly high mortality rate in African-Americans? It’s hard to say for sure, since this data is just now coming to light but it’s something that will definitely become the focus of many a study over the next year (2012). The initial theory had been that African-Americans may suffer higher mortality rates because of a difference in socioeconomic status or health options (insurance plans). However the new study contradicted those theories and pushed the researchers back to square one, figuratively speaking. Hopefully a deeper look into the files of those 50,000 patients plus the addition of more case studies, can help researchers identify a pattern or cause that actually save lives and eliminate the huge discrepancy. Until then, anyone undergoing diverticulitis surgery, especially African-Americans and people considering opting for an emergency surgery, should consider their options very, very carefully before proceeding. While the pain may be intense, even debilitating at times, the risk of losing your life in order to see a rapid relief is not something to take lightly.
What are the options?
First and foremost, consult with your doctor. If your diverticulitis surgery is being scheduled because of abscess or peritonitis concerns, it is probably best to continue with the surgery or you could risk even more pain and disease. However, if the doctor has only recommended surgery or asked you to think about it, check out the other ways first, before making a decision. Consider the route of medication to counter the Diverticulitis, or alternative treatments like the food combining diet recommended by Sherry Brescia. This diet is easy to try, has no serious side effects to worry about, and gives you the chance to cure your diverticulitis without ever stepping foot into an operating room. That’s more than even the surgeons can guarantee, since even surgery only guarantees an 80% chance of a cure.
Full article (taken from http://www.news-medical.net/news/20111122/Racial-disparities-in-emergency-diverticulitis-surgery.aspx):
Black senior citizens who need surgery for the intestinal disorder diverticulitis are significantly more likely to die in the hospital than their equally ill white counterparts, even when each racial group carries the same health insurance, new Johns Hopkins research suggests.
While all of the patients in the study required surgery, black patients were 26 percent more likely than white patients to undergo riskier and more expensive emergency diverticulitis surgery rather than “elective” scheduled surgery for their condition, the Hopkins researchers found. The results emerged in a study of data from Medicare, the government health insurance for senior citizens.
Black seniors also spent more time in the hospital recovering from their operations and the costs of their stays averaged nearly $30,000 more than those of comparable white patients.
Publishing in the November issue of the medical journal Archives of Surgery, the researchers say that while lack of insurance is often a major driver of racial disparities in health care, their analysis shows that even with equal access to a doctor, race-based differences in outcomes persist.
“Even if everyone has coverage, black patients are doing worse, so we need to find out what else is going on,” says study leader Eric B. Schneider, Ph.D., an epidemiologist at the Johns Hopkins Center for Surgical Trials and Outcomes Research. “Maybe then we can make a difference.”
Schneider and his team analyzed data from more than 50,000 Medicare patients who underwent surgery — removal of part of the colon with or without or a colostomy procedure — between 2004 and 2007 in the United States. The researchers, adjusting for age, gender and other underlying illnesses, found that being black was associated with a 28 percent increase in in-hospital mortality, regardless of whether the patient underwent emergency or pre-planned surgery.
Diverticular disease is a common gastrointestinal condition, affecting up to 25 percent of the elderly. In severe cases, it is treated with surgery.
Previous research has found higher rates of mortality, complication and readmission among black surgical patients when compared to white patients undergoing similar procedures. Schneider says the conventional wisdom is that black patients’ poorer outcomes can largely be accounted for by differences in socioeconomic status, including health insurance coverage and greater underlying comorbidity. The new research contradicts that hypothesis, he says.
Schneider says past research has shown that even when they have insurance, black patients are less likely to go to the doctor than white patients, even for routine preventive services such as vaccination. Black patients may also have more undetected or undiagnosed illnesses than white patients, as research shows black patients are less likely to undergo diagnostic evaluations than white patients.
One study, says Schneider, suggested that under-utilization of health care resources by blacks may be related to a higher level of distrust of the medical establishment.
If black seniors were encouraged to see doctors more quickly when they are sick, an illness like diverticulitis could be treated earlier, potentially obviating the need for surgery, or at least allowing for a less-risky, pre-planned operation.
“It may be an access issue. It may be a cultural issue,” he says. “Whites are more likely to have a family practitioner and that may be a factor.”
