Title

The “hispanic paradox” exists in emergent conditions: Better or equivalent surgical outcomes among US hispanic emergency general surgery patients

Document Type

Article

Department

General Surgery

Abstract

Objective: In the United States, Hispanic patients tend to present with similar risk profiles to non-Hispanic black (NHB) patients but experience better outcomes for chronic conditions and elective operations, similar to those of non-Hispanic white (NHW) patients—a phenomenon known as the “Hispanic Paradox.” The finding is thought to be the result of selective migration among foreign-born Hispanic patients, making it theoretically less likely to occur when care is urgent. The objective of this study is to determine whether the “Hispanic Paradox” exists in emergency situations requiring operative emergency general surgery (EGS) care.
Methods: Age-specific differences (pediatric/adult/older adult) in mortality, major morbidity, and unplanned readmission at ≤30, 90, 180, and 365 days among NHW, NHB, and Hispanic patients from three US states with large Hispanic populations were assessed using survival analysis. Data were abstracted from state inpatient claims from 2007 to 2015. Models accounted for clustering of patients within hospitals and states and potential confounding associated with operation type, diagnosis, patient demographics (age, admission year, gender, Charlson Comorbidity Index, income, and insurance), and hospital-level factors (operative volume, rurality, teaching status, and registered nurses (RNs)/bed).
Results: Relative to Hispanic patients, adult NHB and NHW EGS patients fared significantly worse (e.g., ≤365-day mortality hazard ratios (HR) [95% CI]: 1.74 [1.72–1.76], 1.25 [1.24–1.26]). The trend persisted for pediatric (HR [95% CI]: 1.57 [1.50–1.64]) and older adult (1.31 [1.30–1.32]) NHB patients. In contrast, when comparing pediatric NHW vs Hispanic patients, no significant differences in EGS outcomes were found. Among older adults, the apparent protective influence of the Hispanic Paradox waned, pointing to marginally better outcomes among NHW patients aged ≥65 years (HR [95% CI]: 0.94 [0.93–0.95]). Identical patterns were found in major morbidity and unplanned readmission. Differences were most pronounced in adult patients from more ethnically diverse Hispanic states (e.g., Florida vs California) and were markedly reduced by access to insurance.
Conclusion: Outcomes similar to or better than outcomes of US NHW patients were found among US Hispanic patients for EGS. Our findings provide evidence that the “Hispanic Paradox” exists under emergent conditions in contrast to expectations and that its effects appear to decrease with age.

Publication

Panamerican Journal of Trauma Critical Care & Emergency Surgery

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