Structural Racism in Healthcare: Insights into Separate Care for CAP

Segregation of care is less likely in hospitals in the United States (US) that offer coronary artery bypass grafts (CABGs) to large numbers of black patients and also employ large numbers of healthcare professionals . These study results were presented at the 2021 American Heart Association (AHA) Scientific Sessions, which were held virtually November 13-15, 2021.

Black patients who receive coronary bypass surgery are associated with a higher death rate if treatment is provided by a hospital with separate care.

To better assess risk factors for separate care in U.S. hospitals, researchers at the University of Arizona and the University of Michigan pulled data from the Medicare Fee-for-claim database. Service 2012-2018. The risk of receiving high or low segregated care for coronary artery bypass grafting was assessed taking into account the socio-demographic characteristics of the patients, co-morbidities, the hospital, the teams of health professionals and the characteristics of the service area. the hospital.

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A total of 312,503 patients treated in 563 US hospitals were included in the analysis.

The patient population was 84.5% white and 69.9% male.

The low odds of providing separate care were associated with an increased number of black patients receiving coronary artery bypass surgery (odds ratio [OR]0.93; 95% CI, 0.90-0.96) and higher number of healthcare professionals billed (OR, 0.68; 95% CI, 0.59-0.78).

Interestingly, the odds of receiving separate care were not significantly different depending on geographic location. Compared to the South, odds in the Northeast (OR, 3.10; 95% CI, 0.53-18.25), the West (OR, 1.14; 95% CI, 0, 18-7.33) and the Midwest (OR, 1.00; 95% CI, 0.27-3.76) were similar.

No significant trend was observed on the basis of year or other characteristics at the level of patients, hospitals and health services.

The study authors concluded that hospitals in the United States that routinely have a high number of black patients receiving coronary artery bypass grafting and employ a greater number of healthcare professionals were less likely to provide separate care.

“Dismantling structural racism in healthcare requires an investigation of how to replicate the cultural and business models of low-segregation hospitals that promote care for diverse patient populations,” the study authors noted.

Disclosure: Several authors have declared affiliations with the industry. Please refer to the original article for a full list of disclosures.


Breathett K, Hollingsworth J, Shay A, et al. Dismantling structural racism begins with understanding the type of hospitals that provide separate cardiovascular care. Presented at: AHA Scientific Sessions 2021. Abstract 13616

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