Racial disparities in Medicaid patients after brain tumor surgery.

Published

Journal Article

The presence of healthcare-related disparities is an ongoing, widespread, and well-documented societal and health policy issue. We investigated the presence of racial disparities among post-operative patients either with meningioma or malignant, benign, or metastatic brain tumors. We used the Medicaid component of the Thomson Reuter's MarketScan database from 2000 to 2009. Univariate and multivariate analysis assessed death, 30-day post-operative risk of complications, length of stay, and total charges. We identified 2321 patients, 73.7% were Caucasian, 57.8% were women; with Charlson comorbidity scores of <3 (56.2%) and treated at low-volume centers (73.4%). Among all, 26.3% of patients were of African-American ethnicity and 22.1% had meningiomas. Mortality was 2.0%, mean length of stay (LOS) was 9 days, mean total charges were US$42,422, an adverse discharge occurred in 22.5% of patients, and overall 30-day complication rate was 23.4%. In a multivariate analysis, African-American patients with meningiomas had higher odds of developing a 30-day complication (p=0.05) and were significantly more likely to have longer LOS (p<0.001) and greater total charges (p<0.001) relative to Caucasian counterparts. The presence of one post-operative complication doubled LOS and nearly doubled total charges, while the presence of two post-operative complications tripled these outcomes. Patients of African-American ethnicity had significantly higher post-operative complications than those of Caucasian ethnicity. This higher rate of complications seems to have driven greater healthcare utilization, including greater LOS and total charges, among African-American patients. Interventions aimed at reducing complications among African-American patients with brain tumor may help reduce post-operative disparities.

Full Text

Duke Authors

Cited Authors

  • Mukherjee, D; Patil, CG; Todnem, N; Ugiliweneza, B; Nuño, M; Kinsman, M; Lad, SP; Boakye, M

Published Date

  • January 2013

Published In

Volume / Issue

  • 20 / 1

Start / End Page

  • 57 - 61

PubMed ID

  • 23084348

Pubmed Central ID

  • 23084348

Electronic International Standard Serial Number (EISSN)

  • 1532-2653

Digital Object Identifier (DOI)

  • 10.1016/j.jocn.2012.05.014

Language

  • eng

Conference Location

  • Scotland