Hospitalized Black Patients Fare Worse Than White Patients for Adverse Events

Heidi Splete

July 22, 2021

Black patients experience disparities in several safety measures compared to White patients seen at the same hospital, although the data are not consistent across safety measures, according to a report on safety events from 26 states in 2017.

Data from a previous study by the Urban Institute showed that some differences in the higher rates of hospital-acquired injuries and illnesses experienced by Black patients compared to White patients are attributable to differences in hospital quality, but differences in safety events for Black and White patients in the same hospital have not been well studied, write Anuj Gangopadhyaya, PhD, senior research associate in the Health Policy Center at the Urban Institute, Washington, DC. The Urban Institute is a research organization supported in part by the Robert Wood Johnson Foundation.

"Investigating within-hospital racial differences in patient safety is critical to understanding what progress, if any, has been made in improving racial equity in health care," he said.

In a new report published by the Urban Institute, Gangopadhyaha and colleagues used 11 patient safety indicators, including four related to general patient safety and seven related to adverse events associated with surgical procedures, to assess racial disparities in the quality of inpatient care. The report was based on the experiences of Black and White patients in 2017 in 26 states. The investigators used discharge records from the Agency for Healthcare Research and Quality's (AHRQ's) Healthcare Cost and Utilization Project. AHRQ software was used to identify patients who were at risk for a particular event and which patients experienced that event.

The general patient safety indicators were pressure ulcer rate, iatrogenic pneumothorax rate, central venous catheter–related bloodstream infection rate, and in-hospital fall with hip fracture rate. Surgery-related patient safety indicators were perioperative hemorrhage or hematoma rate; the rate of postoperative acute kidney injury that required dialysis; postoperative respiratory failure rate; postoperative pulmonary embolism or deep vein thrombosis rate; postoperative sepsis rate; postoperative wound dehiscence rate; and abdominopelvic accidental puncture or laceration rate.

Complete discharge records were available for 2347 hospitals in the following states: Alaska, Arkansas, Arizona, Colorado, Delaware, Florida, Georgia, Kansas, Kentucky, Massachusetts, Maryland, Michigan, Mississippi, North Carolina, New Jersey, New Mexico, Nevada, Oregon, Rhode Island, South Dakota, Utah, Vermont, Washington, Wisconsin, and West Virginia, as well as the District of Columbia.

Black Patients Fare Worse on Half of Indicators

When admitted to the same hospital, Black adult patients experienced significantly worse safety outcomes compared to White patients of the same age and gender on 6 of 11 safety indicators, including 4 of 7 surgery-related indicators. White patients experienced significantly worse quality of care compared to Black patients on two patient safety indicators. Quality of care was not significantly different for Black patients and White patients on three safety indicators.

Black patients experienced significantly higher rates of pressure ulcers and central venous catheter–related bloodstream infections compared to White patients. White patients experienced significantly higher rates of iatrogenic pneumothorax and in-hospital falls with hip fractures.

"For Black adults, adverse events surrounding surgery-related patient safety measures occur more frequently than the general patient safety indicators," the researchers note. Four of the seven surgery-related indicators were significantly higher for Black patients than for White patients of the same age and gender groups admitted to the same hospital. Rates of perioperative hemorrhage, postoperative respiratory failure, perioperative pulmonary embolism, and postoperative sepsis were 20%, 18%, 30%, and 27% higher, respectively, for Black patients than for White patients of the same age and gender groups admitted to the same hospital.

Compared to White patients, Black patients experienced significantly higher rates of hospital-acquired illness or injury during or shortly following surgical procedures. The differences remained after controlling for insurance type, which suggests that insurance coverage had limited impact on disparities in quality of care, the researchers say.

In hospitals with a larger proportion of Black patients (more than 25%) relative to other hospitals, Black patients had significantly worse rates of adverse patient safety events for 5 of the 6 indicators for which the patients had higher rates overall. Differences in patient safety also reflected the results of the general analysis when the data were analyzed on the basis of hospitals with high resources in comparison with hospitals with low resources, the researchers said.

The study findings were limited by several factors, including the potential misclassification of racial backgrounds by hospitals in comparison with how patients self-identify, the inclusion of data from only 26 states, and variations in insurance plans, the researchers note. "Moreover, this analysis uses data from three years before the COVID-19 pandemic, so many hospital protocols, including patient safety protocols, may have been significantly updated since this analysis," they say.

Patients should be made aware of options for reporting disparities in care, the researchers emphasize. "The Centers for Medicare and Medicaid Services requires hospitals to inform all patients of their rights, including the right to express grievances about the care they receive," they say. "Informing patients of their rights and available means of response to substandard care will help spotlight potentially problematic actors to regulatory agencies, insurers, and peers," they conclude.

The study was funded by the Robert Wood Johnson Foundation. Gangopadhyaya has disclosed no relevant financial relationships.

Urban Institute. "Do Black and White Patients Experience Similar Rates of Adverse Safety Events at the Same Hospital?" Published online July 20, 2021. Abstract

Heidi Splete is a freelance medical journalist with 20 years of experience.

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