A recent article in the British Medical Journal, “Inequities in surgical outcomes by race and sex in the United States,” is important—not for its findings, but for what it reveals about the influence of politically correct thinking on science today and how it is undermining medical progress.
The study examined 30-day postoperative mortality for 1.8 million Medicare patients, aged 65 to 99, who underwent one of eight common types of surgeries from 2016 to 2018—abdominal aortic aneurysm repair, appendectomy, cholecystectomy, colectomy, coronary artery bypass surgery, hip replacement, knee replacement, and lung resection. Seventy percent of these surgeries were elective; the remainder were non-elective (urgent/emergency).
After accounting for other potentially influential factors such as age, disability, and 27 chronic conditions, the researchers found that black men had a higher death rate (3.05 percent) within 30 days of both urgent and elective surgery than white men (2.69 percent), white women (2.38 percent), and black women (2.18 percent). The death-rate disparity between black men and white men was attributable to elective surgery, where black men had a higher death rate (1.3 percent) than white men (0.85 percent), white women (0.82 percent), and black women (0.79 percent). There was no statistically significant difference between black and white men following urgent surgery, with death rates of 6.69 percent and 7.03 percent, respectively.
The authors highlight their finding that black men experience higher mortality after elective surgeries than other subgroups of race and sex. This result, if true, demands an explanation that could lead to improvements in medical and surgical care to narrow or eliminate the disparity.
The authors seem less interested in scientific inquiry than in political posturing, however. Their principal explanation is structural racism—“the impact of racial discrimination across systems in society (including healthcare) that creates inequities in resources and in environments.” This phrase explains everything and nothing at the same time; it does not even conform to other findings within the paper, though the researchers fail to mention this.
White women had significantly worse postoperative mortality than black women for the combined elective and urgent procedures as well as for urgent procedures alone. The two groups of women had no significant mortality difference for elective procedures.
Systemic racism should adversely affect both black women and black men. The various potential systemic factors suggested by the authors—blacks live in poorer neighborhoods with less access to hospitals and specialists and more exposure to environmental hazards such as air pollution; blacks’ social and home situations make them less likely to receive care for their comorbid illnesses that would optimize their condition before surgery, and to enjoy access to postoperative care; historical mistreatment leads black patients to mistrust medical providers—would apply equally to black men and women. Yet black men and white women have worse mortality than their same-gender racial counterparts.
When the authors compared patients seen by the same surgeon, they found that the differential distribution of patients across surgeons reduced the black-to-white male mortality disparity by about a third. But if racism or socioeconomic factors limit black men’s access to better surgeons, there should be a similar effect for black women. Something else must explain why black men do worse.
The finding that surgical mortality is higher among black men is consistent, the authors claim, with data showing that black men have substantially shorter life expectancy at birth compared with other subgroups. But black men’s lower life expectancy at birth compared with other groups is largely due to higher rates of homicide and HIV deaths in young and middle-aged black men. Neither factor has anything to do with postoperative mortality in men over 65.
The all-purpose explanation of racism short-circuits a search for genuine scientific explanations. For example, the authors acknowledge that because of a lack of data, they did not consider obesity (body mass index) and smoking, two conditions clearly connected to postoperative mortality. Rather than concede this deficiency, they claim that systemic racism makes considering these factors unnecessary: “given that processed food, a contributory factor in obesity, and tobacco are more readily available in racially minoritized communities . . . these variables can be seen as factors in the causal pathway linking race and sex with surgical mortality and thus should not be adjusted for in analyses.”
Neither the medical community nor the black men who suffer higher rates of postoperative mortality are well served by this type of so-called scholarship. Yet the article is typical of what is appearing throughout current medical literature. Discovering if and why black men have higher mortality, so that ameliorating policies and treatments can be implemented—instead of parroting politically correct explanations—is a better way to help minority communities.
Photo: FG Trade/iStock