Coronary artery bypass grafting in Native Americans

Nallamothu, Brahmajee K.; Saint, Sanjay; Saha, Som; Fendrick, A. Mark; Kelley, Keith W.; Ramsey, Scott D.

doi:10.1046/j.1525-1497.2001.016008554.x

Cited by 16 publications

(17 citation statements)

References 15 publications

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“…Several potential explanations for this difference exist. In the Nallamothu et al 12 study, AIs were more than 10 times as likely to have their surgery done at a rural, community facility. Also, significant advances in surgical technique have been made since previous reports, including the use of multiple arterial conduits and improved medical and critical care.…”

Section: Discussionmentioning

confidence: 94%

“…This is in contradistinction with earlier reports, in which AI race was identified as an adverse risk factor. 12 In fact, risk-adjusted multivariate logistic regression analysis of the propensity-matched sample suggests that AIs are less likely to have prolonged length of stay and have a lower combined risk of major morbidity/operative mortality or reoperation for any reason (“Adjusted” in Table 4 ). This suggests that when looking at AI and non-AI patients with equal baseline risk factors, AI patients may actually have better outcomes.…”

Section: Discussionmentioning

confidence: 99%

“… 6–11 In an older retrospective study, an in-patient mortality of 4.5% in AIs was reported, significantly higher than for other ethnic groups. 12 …”

Section: Introductionmentioning

confidence: 99%

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Disparities in Cardiovascular Risk Factors in Northern Plains American Indians Undergoing Coronary Artery Bypass Grafting

et al. 2018

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Objectives: Heart disease is the leading cause of death in American Indians (AIs). For AI patients with severe coronary artery disease requiring coronary artery bypass graft (CABG) surgery, little data exist. The purpose of this study was to evaluate short-term outcomes of Northern Plains AI undergoing CABG and identify variations in patient presentation.Methods: All patients undergoing isolated CABG between June 2012 and June 2017 were studied. Seventy-four AI and 1236 non-American Indian (non-AI) patients were identified. Risk factors, preoperative characteristics, cardiac status, procedural information, and outcomes were collected. Univariate analysis comparing short-term clinical outcomes between AI and non-AI populations was performed. Multivariable logistic regression models were constructed and outcome differences assessed. Unadjusted Kaplan–Meier survival estimates were produced using 5-year survival data.Results: AI patients presented with increased risk factors, including higher rates of diabetes mellitus (AI 63.5% vs. non-AI 38.7% p=< 0.001) and smoking/tobacco use (AI 60.8% vs. non-AI 20.0% p=> 0.001). Seventy-nine percent of AI patients resided on or near federal reservations and presented from rural locations. Internal mammary artery (IMA) graft use in both groups was high (AI 95.9% vs. non-AI 94.9% p=0.904), and multiarterial grafting with left internal mammary artery and radial artery use was common in both groups (AI 67.6% vs. non-AI 69.6% p=0.814). No significant differences in unadjusted 30-day mortality or short-term outcomes were detected. Adjusted Kaplan–Meier survival curves were similar between race groups up through 5 years after CABG (p-value=0.38).Conclusion: AIs presented with significantly more risk factors for cardiovascular disease compared with the general population, with especially high rates of insulin-dependent diabetes and active tobacco use. Despite this, outcomes were similar between groups. In propensity-matched groups, AIs were at decreased risk for prolonged length of stay and combined morbidity/mortality. In contrast to previous reports, AI racial identity did not adversely affect survival up to 5 years after CABG.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Disparities in Cardiovascular Risk Factors in Northern Plains American Indians Undergoing Coronary Artery Bypass Grafting

et al. 2018

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“…After being assessed for the availability of data for indigenous vs nonindigenous populations, 80 articles were subsequently removed. Following bibliography scans, contact with international experts, and gray literature search, an additional 9 articles and 7 reports were added, leaving a total of 21 articles [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]42,44 and 7 reports 14,[45][46][47][48][49][50] from 27 studies for data extraction.…”

Section: Resultsmentioning

confidence: 99%

“…Meta-data for all included studies are presented in Table 2. Of 21 articles, 11 studies were conducted in the US, [26][27][28][29]31,[35][36][37][38]42,51 7 in Australia, 25,30,33,34,39,40,44 and 2 in New Zealand. 32,43 All were cohort studies, with 17 retrospective studies 25,[28][29][30][31][32][33][35][36][37][38][39][41][42][43][44]51 and3prospective studies (from 4 articles).…”

Section: Study Characteristicsmentioning

confidence: 99%

Postoperative Mortality of Indigenous Populations Compared With Nonindigenous Populations

et al. 2020

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IMPORTANCEA range of factors have been identified as possible contributors to racial/ethnic differences in postoperative mortality that are also likely to hold true for indigenous populations. Yet despite its severity as an outcome, death in the period following a surgical procedure is underresearched for indigenous populations.OBJECTIVE To describe postoperative mortality experiences for minority indigenous populations compared with numerically dominant nonindigenous populations and examine the factors that drive any differences observed.EVIDENCE REVIEW This review was conducted according to PRIMSA guidelines and registered on PROSPERO. Articles were identified through searches of the Embase, Ovid MEDLINE, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases, with manual review of references and gray literature searches conducted. Eligible articles included those that reported associations between ethnicity/indigeneity and mortality up to 90 days following surgery and published in English between January 1, 1990, and March 26, 2019. Data on the study design, setting, participants (including indigeneity), and results were extracted. A modified Newcastle-Ottawa Quality Assessment Scale was used to determine study quality.FINDINGS A total of 442 abstracts were screened, 92 articles were reviewed in full text, and 21 articles (from 20 studies) and 7 reports underwent data extraction. All included studies were cohort studies (3 prospective and the remainder retrospective) investigating a wide range of surgical procedures in the US, Australia, or New Zealand. Seven studies were from single facilities, while the remainder used data from national databases. Sample sizes ranged, with indigenous sample sizes ranging from 20 to 3052 patients and a number of studies reporting less than 10 indigenous deaths. The postoperative mortality experience for minority indigenous populations compared with the nonindigenous populations was mixed. There was evidence from several studies that indigenous populations may be more likely to die following cardiac procedures. However, the available evidence has overall poor study quality, with methods to identify the indigenous populations being a major limitation of most of the studies. CONCLUSIONS AND RELEVANCEPostoperative mortality experiences for indigenous populations should not be interpreted in isolation from the broader context of inequities across the health care pathway and must take into account the quality of data used for indigenous identification.

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Cancer Surgery Among American Indians

Markin

Habermann²,

Zhu³

et al. 2013

JAMA Surg

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Importance: American Indians (AIs) have the poorest cancer survival rates of any US ethnic group. Late diagnosis, poor access to specialty care, and delays in therapy likely contribute to excess mortality. Surgery plays a central role in therapy for solid organ cancer.Objective: To determine whether operative outcomes also contribute to poor long-term survival among AI patients with cancer.Design: Population-based retrospective cohort study comparing patient-and hospital-level factors and shortterm operative outcomes for AI and non-Hispanic white patients. Survey-weighted multivariate analyses assessed the effect of AI ethnicity on hospital location, inhospital mortality, and prolonged length of stay. Results: Of 740 878 patients who met our inclusion criteria, 3048 were AIs. The AI patients were younger, more likely to undergo cancer surgery at rural hospitals, and more likely to be admitted for nonelective procedures and had more comorbidities than non-Hispanic white patients of similar ages (all, P Ͻ .05). The AI patients had comparable inpatient mortality and length of stay. Conclusions and Relevance:This investigation is the largest study of surgical outcomes among AIs to date and the first to focus on cancer surgery. This relatively young cohort does not experience poor outcomes after oncologic resection. Future research should uncover other factors in the continuum of cancer care that may contribute to the poor long-term survival of AI patients with cancer, including delivery of perioperative therapies. JAMA Surg. 2013;148(3):277-285A MERICAN INDIANS (AIS) have the worst cancer survival rates of any US ethnic group, 1 and available evidence suggests that mortality due to cancer among AIs is increasing.2 Relative to non-Hispanic white (NHW) patients, AI patients present with more advanced stages of cancer, 3 are less likely to receive appropriate therapy, 4 and experience significant delays between diagnosis and surgical intervention. 5 Indeed, the most recent data from the American Cancer Society indicate that AI and Alaskan Native women are the only demographic groups not to benefit from a remarkable decline in cancer death rates during the past decade. Oncologic resection represents a critical component of therapy for most solid malignant neoplasms. However, a paucity of information is available regarding the AI cancer surgery experience, although significant research has been dedicated to disparities in surgical oncology for other ethnic and racial minorities. 7 Several obstacles limit research of this type among AIs, including small numbers of available subjects, regional and tribal heterogeneity, 2 and racial miscategorization. 8 As such, we do not know how or whether unique patterns of oncologic resections contribute to poor long-term cancer survival among AI patients.To better understand the origins of excess long-term cancer mortality among AIs, this study used a large national database to examine short-term operative outcomes. We compared patient characteristics, hospital characteristics, and hos...

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Coronary artery bypass grafting in Native Americans

Abstract: The risk of in-hospital death following CABG may be higher in Native Americans than in other ethnic groups. Given the small number of Native Americans in the database (n = 155), however, further research will be needed to confirm these findings.

Cited by 16 publications

References 15 publications

Disparities in Cardiovascular Risk Factors in Northern Plains American Indians Undergoing Coronary Artery Bypass Grafting

Disparities in Cardiovascular Risk Factors in Northern Plains American Indians Undergoing Coronary Artery Bypass Grafting

Postoperative Mortality of Indigenous Populations Compared With Nonindigenous Populations

Cancer Surgery Among American Indians

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