New Study Questions Disparities in Vascular Surgery Among Hispanics

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Hispanics in the United States receive fewer vascular surgeries than the general population and have worse outcomes in some cases, according to new research, which also finds that Hispanics often seek treatment only after developing more advanced disease. Reasons for the disparities are not fully understood, but may include a combination of socioeconomic factors and genetic variations.

Published in the November Journal of Vascular Surgery, the study was led by a vascular surgery team from NewYork-Presbyterian Hospital, Columbia University Medical Center and Weill Cornell Medical College.

Using medical records from hospitals in New York and Florida from the years 2000 to 2004, researchers looked at three common vascular surgery procedures—lower extremity revascularization (LER), carotid revascularization (CR), and abdominal aortic Aneurysm (AAA) repair.

They found that Hispanic patients, compared to non-Hispanic whites, had higher rates of amputation following lower extremity revascularization (a surgical procedure to restore blood supply to a body part or organ) (6.2% vs. 3.4%) and greater risk for death following elective AAA repair (5.0% v. 3.4%). Additionally, Hispanic patients were as much as two times more likely than whites to seek treatment only after developing more advanced disease. They also spend more time in the hospital recovering.

“These are significant disparities, and the reasons for them must be determined in order to make improvements,” says the study’s principal investigator, Dr. Nicholas J. Morrissey, director of clinical trials and a vascular surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center and assistant professor of surgery at Columbia University College of Physicians and Surgeons and Weill Cornell Medical College. “One explanation may be socioeconomic factors, particularly insurance status, which could impede Hispanic patients’ access to proper preventive and diagnostic care.”

In addition, the study notes that Hispanics traditionally rely on self-care methods and are reluctant to seek professional treatment, and may even be less “willing” to consider prophylactic surgical interventions. It is also possible that there are genetic differences in the nature and manifestation of vascular disease.

Consistent with previous studies, the study also found elevated rates of diabetes, renal failure and hypertension among Hispanic patients. According to the authors, efforts directed at detection and control of these conditions would be an important component of a strategy aimed at addressing vascular disease for this population. However, they note that Hispanic ethnicity remained associated with more advanced disease even after controlling for coexisting co-morbidities, including diabetes—a fact that points toward other explanations.

“The Hispanic population represents the fastest growing minority in the United States. As the population grows and ages, the vascular surgery community will be providing increasing amounts of care to this diverse group,” Dr. Morrissey says.

Previous research cited by the study shows that ethnicity and race are predictors of screening disparities, treatment variations and health outcomes. Racial differences in utilization of surgical procedures have been seen in a wide variety of procedures—including joint replacements, myocardial revascularization, renal transplant and even dialysis access. Among a variety of explanations are genetic variations, lack of screening, inferior access to care and awareness, delayed intervention and treatment discrepancies. Research has shown that these differences did not lessen significantly during the 1990s.

Additional co-authors from Weill Cornell Medical College and Columbia University College of Physicians and Surgeons—affiliates of NewYork-Presbyterian Hospital—include senior author Dr. K. Craig Kent, Dr. Jeannine K. Giacovelli, Natalia Egorova, Dr. Annetine Gelijns, Dr. Alan Moskowitz and Dr. James McKinsey; and, from Columbia University Medical Center’s International Center for Health Outcomes and Innovation Research, Dr. Giampaolo Greco, Dr. Annetine Gelijns, Dr. Alan Moskowitz and Natalia Egorova.

NewYork-Presbyterian Hospital
NewYork-Presbyterian Hospital—based in New York City—is the nation’s largest not-for-profit, non-sectarian hospital, with 2,242 beds. It provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, Morgan Stanley Children’s Hospital of NewYork-Presbyterian, NewYork-Presbyterian Hospital/Allen Pavilion and NewYork-Presbyterian Hospital/Westchester Division. One of the largest and most comprehensive health-care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. It ranks sixth in U.S.News & World Report’s guide to “America’s Best Hospitals,” ranks first on New York magazine’s “Best Hospitals” survey, has the greatest number of physicians listed in New York magazine’s “Best Doctors” issue, and is included among Solucient’s top 15 major teaching hospitals. The Hospital is ranked with among the lowest mortality rates for heart attack and heart failure in the country, according to a 2007 U.S. Department of Health and Human Services (HHS) report card. The Hospital has academic affiliations with two of the nation’s leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons.

Source: NewYork-Presbyterian Hospital

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