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Are racial differences in hospital mortality after coronary artery bypass graft surgery real? A risk-adjusted
Umberto Benedetto1, Mohamed K Kamel2, Faiza M Khan2
1Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom.
Insights
Racial disparities persist in hospital mortality after coronary artery bypass grafting (CABG). Black patients face higher risks, while Asian and Hispanic patients show no significant difference compared to white patients, despite overall declining mortality rates.
Area of Science:
- Cardiovascular Surgery
- Health Disparities
- Medical Outcomes
Background:
- Conflicting data exists regarding the influence of ethnicity on mortality rates following coronary artery bypass grafting (CABG).
- Previous reports have not definitively established the impact of race on post-CABG outcomes.
Purpose of the Study:
- To investigate the effect of race on in-hospital mortality after CABG.
- To provide further insights into ethnic disparities in cardiovascular surgery outcomes through a risk-adjusted meta-analysis.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Embase, BioMed Central, Cochrane).
- Pairwise meta-analysis and risk-adjusted meta-analytic estimates using generic inverse variance methods with a random effect model were employed.
- Hospital mortality data from 28 studies comparing black, Hispanic, and Asian patients against white patients were analyzed.
Main Results:
- Black patients had a significantly greater adjusted risk of hospital death (OR, 1.25; 95% CI, 1.13-1.39) compared to white patients.
- No statistically significant difference in adjusted hospital death risk was observed for Asian (OR, 1.33; 95% CI, 0.99-1.77) or Hispanic patients (OR, 1.08; 95% CI, 0.94-1.23).
- Meta-regression revealed a trend toward lower mortality rates in recent studies across most groups, but the relative disadvantage persisted.
Conclusions:
- Ethnic disparities in hospital mortality after CABG persist, despite overall reductions in mortality rates.
- The findings highlight the continued need to address racial/ethnic inequalities in cardiovascular surgical outcomes.
Background:
Despite several reports, there are still conflicting data on the influence of ethnicity on mortality rates associated with coronary artery bypass grafting (CABG). We aimed to get further insights into the effect of race on mortality following CABG by performing a risk adjusted meta-analysis.
Methods:
Relevant studies were searched on PubMed, Embase, BioMed Central, and the Cochrane Central register. Pairwise meta-analysis was used to estimate the relative risk of hospital death of black, Hispanic, and Asian patients using white patients as reference. Risk adjusted meta-analytic estimates were obtained using generic inverse variance methods with random effect model.
Results:
A total of 28 studies were selected for analysis. A total of 21 studies reported on hospital mortality in black (n = 222,892) versus white (n = 3,884,043) patients, 7 studies reported on Hispanic (n = 91,256) versus white (n = 1,458,524) and 9 studies reported on Asian (n = 27,820) versus white (n = 1,081,642). When compared with white patients, adjusted risk of hospital death was significantly greater for black patients (adjusted odds ratio [OR], 1.25; 95% confidence interval [CI], 1.13-1.39; P < .001), and not statistically different for Asian (OR, 1.33; 95% CI, 0.99-1.77; P = .05) and Hispanic patients (adjusted OR, 1.08; 95% CI, 0.94-1.23; P = .26). Meta-regression showed a significant trend toward lower mortality rates in most recent series in both black (P = .02) and white (P = .0007) and Asian (P = .01) but not for Hispanic (P = .41). However, as mortality rates were lower across the different races, the relative disadvantage between the study groups persisted, which may explain the lack of interaction between study period and race effect on mortality for black (adjusted P = .09), Asian (adjusted P = .63), and Hispanic (adjusted P = .97) patients.
Conclusions:
The present meta-analysis showed that despite progress is being made in lowering in-hospital mortality rates among the major racial/ethnic groups, ethnical disparities in hospital mortality after CABG remain.
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