Association Between the COVID-19 Pandemic and Disparities in Access to Major Surgery in the US.
Association Between the COVID-19 Pandemic and Disparities in Access to Major Surgery in the US.
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DOI：
10.1001/jamanetworkopen.2022.13527
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发表时间：
2022-05-02
影响因子：
13.8
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中科院分区：
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在新冠肺炎大流行的第一波期间，联邦医疗保险和医疗补助服务中心暂停了选择性手术，与白人相比，黑人、亚洲人和其他种族的人每月选择性手术例数的变化之间有什么联系？在这项对3名接受大手术的 470 905成年人的横断面研究中，在联邦医疗保险和医疗补助服务中心暂停期间，黑人个人、亚洲人和其他种族的人的选择性手术病例量的减少并不比白人个人的减少更大。这些发现表明，对大流行的早期反应并没有增加获得外科治疗的差距。这项对接受大手术的成年人进行的横断面研究评估了在第一波新冠肺炎大流行期间是否出现了获得手术护理的种族差异。在与新冠肺炎无关的额外死亡中，少数民族占了70%。了解医疗保险和医疗补助服务中心(CMS)暂停对存在种族差异的非必要手术的关联将有助于塑造未来的大流行应对措施。评估在新冠肺炎大流行的第一波期间，CMS暂停选择性手术在黑人个体、亚洲个体以及与白人个体相比的其他种族个体之间的关联性。这项横断面研究评估了2018年1月1日至2020年10月31日期间因大手术而住院的3 470 905成人住院患者的719家医院的回顾队列。2020年3月1日至2020年5月31日期间的第一波新冠肺炎感染。主要结果是每月择期手术病例数量的变化和作为患者种族函数的第一波新冠肺炎感染之间的关联，使用负二项回归分析进行评估。在因大手术住院的3名 470 905成人(1名 823 816女性[52.5%])中，70名 752(2.0%)是亚洲人，453名 428(13.1%)是黑人，2 696 929(77.7%)是白人，249名 796(7.2%)是其他种族的个体。与基准期相比，第一波期间每月选择病例的数量为49%(发病率比为0.49；95%可信区间为0.486-0.492；P <； .001)。与基准期相比，黑人(未调整的内部收益率，0.99；95%CI，0.97-1.01；P = .36)、亚洲人(未调整的内部收益率，1.08；95%CI，1.03-1.14；P = .001)和其他种族个人(未调整的内部收益率，0.97；95%CI，0.95-1.00；P = .05)的未调整择期手术病例的相对减少与白人病例的变化非常接近。在对年龄、性别、合并症和手术程序进行调整后，仍然没有证据表明第一波大流行与获得择期手术的机会不同有关。在这项横断面研究中，CMS暂停非必要手术与选择性手术减少51%有关。与白人个人相比，这并不意味着少数族裔个人的手术减少得更多。这一证据表明，对大流行的早期反应并没有增加获得外科治疗的差距。
What is the association between the Centers for Medicare & Medicaid Services moratorium on elective operations during the first wave of the COVID-19 pandemic and changes in the monthly elective surgical case volumes among Black individuals, Asian individuals, and individuals of other races compared with White individuals? In this cross-sectional study of 3 470 905 adults undergoing major surgery, the reduction in elective surgery case volumes during the Centers for Medicare & Medicaid Services moratorium was not greater for Black individuals, Asian individuals, and individuals of other races than for White individuals. These findings suggest that the early response to the pandemic did not increase disparities in access to surgical care. This cross-sectional study of adults undergoing major surgery evaluates whether racial disparities in access to surgical care occurred during the first wave of the COVID-19 pandemic. 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. 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. This cross-sectional study assessed a 719-hospital retrospective cohort of 3 470 905 adult inpatient hospitalizations for major surgery between January 1, 2018, and October 31, 2020. The first wave of COVID-19 infections between March 1, 2020, and May 31, 2020. 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. Among 3 470 905 adults (1 823 816 female [52.5%]) with inpatient hospitalizations for major surgery, 70 752 (2.0%) were Asian, 453 428 (13.1%) were Black, 2 696 929 (77.7%) were White, and 249 796 (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. 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.