Racial and Ethnic Disparities in Interhospital Transfer for Complex Emergency General Surgical Disease Across the United States.

BACKGROUND
Differential access to specialty surgical care can drive healthcare disparities, and interhospital transfer (IHT) is one mechanism through which access barriers can be realized for vulnerable populations. The association between race/ethnicity and IHT for patients presenting with complex emergency general surgery (EGS) disease is understudied.


METHODS
Using the 2019 Nationwide Emergency Department Sample, we identified patients aged ≥18 years with 1 of 13 complex EGS diseases based on International Classification of Diseases 10th Edition Diagnosis Codes. The primary outcome was IHT. A series of weighted logistic regression models were created to determine the association of race/ethnicity with the primary outcome while controlling for patient and hospital characteristics.


RESULTS
Of 387,610 weighted patient encounters from 989 hospitals, 59,395 (15.3%) patients underwent IHT. Compared to Non-Hispanic White (NHW) patients, rates of IHT were significantly lower for Non-Hispanic Black (NHB) (15% vs. 17%, unadjusted odds ratio (uOR) [95% CI]: 0.58 [0.49 - 0.68], p < .001), Hispanic/Latinx (HL) (9.0% vs. 17%, uOR [95% CI]: 0.48 [0.43 - 0.54], p < .001), Asian/Pacific Islander (Asian/PI) (11% vs. 17%, uOR [95% CI]: 0.84 [0.78 - 0.91], p < .001), and other race/ethnicity (12% vs 17%, uOR [95% CI]: 0.68 [0.57 - 0.81], p < .001) patients. In multivariable models, the adjusted odds of IHT remained significantly lower for HL (aOR [95% CI]: 0.76 [0.72 - 0.83], p < .001) and Asian/PI (aOR [95% CI]: 0.73 [0.62 - 0.86], p < .001) patients, but not for NHB and other race/ethnicity patients (p > .05).


CONCLUSIONS
In a nationally representative sample of Emergency Departments across the United States, patients of minority race/ethnicity presenting with complex EGS disease were less likely to undergo IHT when compared to NHW patients. Disparities persisted for HL and Asian/PI patients when controlling for comorbid conditions, hospital and residential geography, neighborhood socioeconomic status, and insurance; these patients may face unique barriers in accessing surgical care.


LEVEL OF EVIDENCE
Level III, Prognostic/Epidemiological.