Impact of More Detailed Measures of Disease Severity on Racial Disparities in Cardiac Surgery Mortality among Native Hawaiians and Pacific Islanders.

Publisher: University Health Partners of Hawaiʻi Country of Publication: United States NLM ID: 101750601 Publication Model: Print Cited Medium: Internet ISSN: 2641-5224 (Electronic) Linking ISSN: 26415216 NLM ISO Abbreviation: Hawaii J Health Soc Welf Subsets: MEDLINE

Original Publication: Honolulu, Hawaiʻi : University Health Partners of Hawaiʻi, [2019]-

Cardiac Surgical Procedures*/mortality ; Native Hawaiian or Other Pacific Islander*/statistics & numerical data ; Patient Acuity* ; Health Status Disparities* ; Heart Diseases*/diagnosis ; Heart Diseases*/epidemiology ; Heart Diseases*/ethnology ; Heart Diseases*/surgery; Humans ; Comorbidity ; Diabetes Mellitus/epidemiology ; Diabetes Mellitus/ethnology ; Hospital Mortality/ethnology ; Severity of Illness Index ; Liver Diseases/epidemiology ; Liver Diseases/ethnology ; Kidney Diseases/epidemiology ; Kidney Diseases/ethnology

Studies that examine racial disparities in health outcomes often include analyses that account or adjust for baseline differences in co-morbid conditions. Often, these conditions are defined as dichotomous (Yes/No) variables, and few analyses include clinical and/or laboratory data that could allow for more nuanced estimates of disease severity. However, disease severity - not just prevalence - can differ substantially by race and is an underappreciated mechanism for health disparities. Thus, relying on dichotomous disease indicators may not fully describe health disparities. This study explores the effect of substituting continuous clinical and/or laboratory data for dichotomous disease indicators on racial disparities, using data from the Queen's Medical Center's (QMC) cardiac surgery database (a subset of the national Society of Thoracic Surgeon's cardiothoracic surgery database) as an example case. Two logistic regression models predicting in-hospital mortality were constructed: (I) a baseline model including race and dichotomous (Yes/No) indicators of disease (diabetes, heart failure, liver disease, kidney disease), and (II) a more detailed model with continuous laboratory values in place of the dichotomous indicators (eg, including Hemoglobin A1c level rather than just diabetes yes/no). When only dichotomous disease indicators were used in the model, Native Hawaiian and other Pacific Islander (NHPI) race was significantly associated with in-hospital mortality (OR: 1.57[1.29,2.47], P=.04). Yet when the more specific laboratory values were included, NHPI race was no longer associated with in-hospital mortality (OR: 1.67[0.92,2.28], P=.28). Thus, researchers should be thoughtful in their choice of independent variables and understand the potential impact of how clinical measures are operationalized in their research.
Competing Interests: None of the authors identify a conflict of interest.
(©Copyright 2023 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Am J Public Health. 2019 Jan;109(S1):S16-S20. (PMID: 30699025)
Neurology. 2013 Feb 26;80(9):839-43. (PMID: 23365055)
J Am Coll Cardiol. 2013 Sep 10;62(11):1026-34. (PMID: 23644082)
Healthc (Amst). 2017 Sep;5(3):112-118. (PMID: 27932261)
Health Serv Res. 2015 Aug;50 Suppl 1:1351-71. (PMID: 26073945)
Epidemiol Rev. 2009;31:113-29. (PMID: 19531765)
Clin Cardiol. 2005 Sep;28(9):429-32. (PMID: 16250266)
BMJ. 2009 Jun 29;338:b2393. (PMID: 19564179)
Hawaii Med J. 2010 May;69(5 Suppl 2):28-30. (PMID: 20544607)

Keywords: Dichotomous Indicators; Disparities; Prediction; Risk Modeling; Statistical Methods

Date Created: 20231030 Date Completed: 20231204 Latest Revision: 20240426

20240426

PMC10612420

37901671