Racial differences may reflect inequities in access to surgical care for Black, Latino, and Asian children

The number of surgeries performed on Black, Latino, and Asian children is significantly lower than among white children in the United States, a UT Southwestern study has found. These differences may reflect inequities in access to surgical care.

The study, published in the Journal of Pediatric Surgery, examined surgery data for more than 200,000 children from the 1999-2018 National Health Interview Surveys. Even after adjusting for demographic factors that might affect surgery rates such as insurance status, poverty, and citizenship, researchers found fewer surgeries reported by parents of Black, Latino, and Asian children.

We found that Black, Latino, and Asian children were roughly half as likely as white children to have had surgery in the prior 12 months. For children who had surgery, we also found differences in the types of surgery obtained, notably that Latino children were more likely to require urgent or emergent surgery."

Ethan Sanford, M.D., Assistant Professor of Anesthesiology and Pain Management at UT Southwestern and First Author

The study does not identify the cause of the differences, and it's uncertain if the results indicate overuse of surgery by white families or underuse by Black, Latino, and Asian families. But the researchers said the observed differences in the odds of surgery by race and ethnic group suggest that Black, Latino, and Asian children may disproportionately face barriers to timely, optimal care. Systems-level factors that may contribute to this include lack of reliable transportation, inflexibility of workplace schedules to allow parents and guardians time off work to attend appointments, and/or ineffective communication from health care providers, including language barriers.

"These data raise the concern that minority children are less likely to receive indicated surgery at the most opportune time," Dr. Sanford said. "Additionally, if surgery is omitted or delayed, minority children may have worsening disease that then requires more emergent care, which carries more risk."

The findings corroborate and add to the growing evidence of ethnic differences among children throughout the U.S. health care system. Previous studies have shown that among children with appendicitis, Black children have a significantly higher risk than white children of delayed diagnosis, complications, and perforation. There is also evidence that Black children with minimal health problems undergoing inpatient surgery are three times more likely to die within 30 days of surgery compared with white children.

Dr. Sanford and his colleagues said their findings should be considered in the context of documented racial and ethnic disparities.

"We hope that this work helps to reduce disparities in surgical access for minority children by raising awareness among clinicians, increasing monitoring so that any disparities can be identified expeditiously, stimulating rapid-cycle quality improvement when disparities are identified, and prompting further research. Every child in America deserves access to the right surgical care at the right time, regardless of skin color," he said.

Other UTSW researchers who contributed to this study include Rasmi Nair, Adam Alder, and Peter Szmuk.