Black Patients in US Face Delays in Kidney Stone Surgery Regardless of Insurance Status

By Shawana Alleyne-Morris

May 05, 2022

NEW YORK (Reuters Health) - Black patients who visited the emergency department (ED) for nephrolithiasis were more likely than patients of other races to experience delays in surgery regardless of insurance status, researchers found.

"We found that Black patients in the study waited, on average, 10-13 days longer than Hispanic and ethnically unidentified patients in the study, who had the shortest time to surgery (38.5 vs 25-28 days)," Dr. Justin Ziemba and Dr. Esther Nivasch Turner of the Perelman School of Medicine at the University of Pennsylvania, in Philadelphia, told Reuters Health by email. "This was independent of economic factors, though Black patients tended to be more likely to be uninsured or on Medicaid."

"To give some context," they added, "our generally older, white patients waited on average 36 days to surgery, possibly because they needed more time to schedule medical clearance appointments before their surgery."

Their team studied 682 patients with kidney stones at three EDs in the Philadelphia area, of whom 6.9%, 17.7%, 26.7%, and 48.6% self-identified as Hispanic, Other, Black, and white, respectively.

Overall, 19 patients were uninsured, 132 were enrolled in Medicaid, 159 were enrolled in Medicare and 372 had commercial insurance. All eventually underwent definitive surgical stone removal via ureteroscopy, extracorporeal shockwave lithotripsy or percutaneous nephrolithotomy.

Surgery wait times ranged from 10 to 72 days. Black patients waited an average of 39 days while Hispanic patients experienced a wait time of 28 days (p=0.007)

Those who were uninsured had the shortest wait time, of 21 days, although wait-time disparities based on insurance status were not statistically significant.

Signs and symptoms - e.g., stone size, fevers, and concerning imaging findings - were not clinically different in the patient groups, the researchers report in Urology.

While Black patients were more likely to be uninsured, their wait time was still the longest.

"It is challenging to directly identify the factors that best predict expedient surgical scheduling for kidney and ureteral stones, especially without more research and follow-up studies," Drs. Ziemba and Nivasch Turner said.

Their team speculates that along with the racial disparities that exist across all medical and surgical institutions, patients' access to paid time off, family obligations, low health literacy and access to reliable transportation may have contributed to Black patients' longer time to surgery.

These factors "are likely to be found across the United States," they noted.

Physician biases may also play a role in the delays. For example, the two authors suggested, "We can hypothesize, given our understanding of our specific healthcare system... that healthcare workers assume that Black patients who have insurance (most of our patients) will have no issues with surgical scheduling, and do not devote additional attention to (it)."

SOURCE: Urology, online April 21, 2022.