Racial Disparities are Present in the Timing of Radiographic Assessment and Surgical Treatment of Hip Fractures

Abstract

Survey Background This report is part of a series titled "Discrimination in America." The series is based on a survey conducted for National Public Radio, the Robert Wood Johnson Foundation, and Harvard T.H. Chan School of Public Health. The survey was conducted January 26-April 9, 2017, among a nationally representative, probability-based telephone (cell and landline) sample of 3,453 adults age 18 or older. The survey included nationally representative samples of African Americans, Latinos, Asian Americans, Native Americans, whites, men, women, and LGBTQ adults. This report presents the results specifically for a nationally representative probability sample of 802 African-American U.S. adults. Future reports will analyze each other group, and the final report will discuss major highlights from the series. Discrimination is a prominent and critically important matter in American life and throughout American history. While many surveys have explored Americans' beliefs about discrimination, this survey asks people about their own personal experiences with discrimination. Summary: Personal Experiences of Discrimination Overall, African Americans report extensive experiences of discrimination, across a range of situations. In the context of institutional forms of discrimination, half or more of African Americans say they have personally been discriminated against because they are Black when interacting with police (50%), when applying to jobs (56%), and when it comes to being paid equally or considered for promotion (57%). Additionally, 60% of African Americans say they or a family member have been unfairly stopped or treated by the police because they are Black, and 45% say the court system has treated them unfairly because they are Black. Blacks living in suburban areas are more likely than those in urban areas to report being unfairly stopped or treated by police and being threatened or harassed because they are Black. 1 See for example, Fred Pincus (1996), "Discrimination Comes in Many Forms," American Behavioral Scientist 40(2):186-194, for distinctions between structural, institutional, and individual forms of discrimination. Notes on Report Language In this report, the terms "Black" and "African American" are used interchangeably. This report distinguishes between institutional and individual forms of discrimination, though discrimination comes in many forms. 1 In this report, the term "institutional discrimination" refers to forms of discrimination based on laws, policies, institutions, and the related behavior of individuals who work in or control those laws, policies, or institutions. The term "individual discrimination" refers to forms of discrimination based in individual people's prejudicial beliefs, words, and behavior. These are not necessarily mutually exclusive, but the distinction is used for organizing purposes. In this survey, people were asked whether they had ever personally experienced discrimination related to racism, sexism, andfor LGBTQ peoplehomophobia and transphobia. Questions about these...

Timeliness of Care for High‐acuity Conditions at Hospital‐affiliated Freestanding Emergency Departments

“…While we did not analyze the impact of patient characteristics, such as race or ethnicity, on timeliness of care, other studies have found that nonwhite patients may be subject to assessment and treatment delays in the ED. 18,19 If similar trends hold true in our sample, it is possible that our study underestimates the magnitude of difference in high-acuity care timeliness between FREDs and HEDs.…”

“…Of note, as previously demonstrated, 11 we found that the baseline characteristics of patient visits to FREDs and HEDs were different, with FREDs tending to serve fewer minority patients. While we did not analyze the impact of patient characteristics, such as race or ethnicity, on timeliness of care, other studies have found that nonwhite patients may be subject to assessment and treatment delays in the ED 18,19 . If similar trends hold true in our sample, it is possible that our study underestimates the magnitude of difference in high‐acuity care timeliness between FREDs and HEDs.…”

Review article: Implicit bias towards Aboriginal and Torres Strait Islander patients within Australian emergency departments

“…International evidence illustrates how racial and ethnic groups experience disparities in triage scores, 14 radiographic assessment, 15 coronary angiography, 16 surgical waiting times 17 and analgesia recommendations 18 . Studies have shown that Indigenous Australians have a higher admission rate, 19 greater severity of illness 19 and higher burden of cardiometabolic comorbidities 20 .…”

Racial Disparity in Time to Surgery and Complications for Hip Fracture Patients

“…5) In another study of 5 intraregional hospitals, the authors found that black patients had a significantly longer delay to radiography and surgery from initial presentation. 6) To better understand the effects of race on hip fracture care across a wider set of hospitals, our objective was to determine whether race is associated with longer time to surgery from hospital presentation and increased perioperative complications by using the National Surgical Quality Improvement Program (NSQIP).…”

“… 5) In another study of 5 intraregional hospitals, the authors found that black patients had a significantly longer delay to radiography and surgery from initial presentation. 6) …”