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VOLUME 8 , ISSUE 1 ( January-April, 2019 ) > List of Articles

Original Article

The “Hispanic Paradox” Exists in Emergent Conditions: Better or Equivalent Surgical Outcomes Among US Hispanic Emergency General Surgery Patients

Cheryl K Zogg, Tarsicio Uribe-Leitz, Nizar Bhulani, Shahid Shafi, Carlos A Ordóñez, Kimberly A Davis, Adil H Haider

Keywords : Emergency general surgery, Hispanic Paradox, Morbidity, Mortality, Race/ethnicity, United States, Unplanned readmission

Citation Information : Zogg CK, Uribe-Leitz T, Bhulani N, Shafi S, Ordóñez CA, Davis KA, Haider AH. The “Hispanic Paradox” Exists in Emergent Conditions: Better or Equivalent Surgical Outcomes Among US Hispanic Emergency General Surgery Patients. Panam J Trauma Crit Care Emerg Surg 2019; 8 (1):36-51.

DOI: 10.5005/jp-journals-10030-1235

License: CC BY-NC 4.0

Published Online: 04-04-2019

Copyright Statement:  Copyright © 2019; The Author(s).


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.

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  1. United States Census Bureau. United States Census 2020. 2018. Accessed 15 July 2018. Available from: https://www.census. gov/2020census
  2. Ruiz JM, Steffen P, et al. Hispanic mortality paradox: a systematic review and meta-analysis of the longitudinal literature. Am J Public Health 2013;103(3):e52–e60. DOI: 10.2105/AJPH.2012.301103.
  3. Goldman N. Will the Latino mortality advantage endure? Res Aging 2016;38(3):263–282. DOI: 10.1177/0164027515620242.
  4. Shor E, Roelfs D, et al. The “Hispanic Mortality Paradox” revisited: meta-analysis and meta-regression of life-course differentials in Latin American and Caribbean immigrants’ mortality. Soc Sci Med 2017;186:20–33. DOI: 10.1016/j.socscimed.2017.05.049.
  5. Tarraf W, Jensen GA, et al. Trajectories of aging among US older adults: mixed evidence for a Hispanic Paradox. J Gerontol B Psychol Sci Soc Sci. 2018. DOI: 10.1093/geronb/gby057.
  6. Osler T, Glance LG, et al. Trauma care does not discriminate: the association of race and health insurance with mortality following traumatic injury. J Trauma Acute Care Surg 2015;78(5):1026–1033. DOI: 10.1097/TA.0000000000000593.
  7. Medina-Inojosa J, Jean N, et al. The Hispanic Paradox in cardiovascular disease and total mortality. Prog Cardiovasc Dis 2014;57(3):286–292. DOI: 10.1016/j.pcad.2014.09.001.
  8. Desai N, Lora CM, et al. CKD and ESRD in US Hispanics. Am J Kidney Dis 2018;73(1):102–111.
  9. Budnick HC, Lee IL, et al. Hispanic ethnicity and complication profile following laparoscopic and open cholecystectomy. J Surg Res 2017;219:33–42. DOI: 10.1016/j.jss.2017.05.121.
  10. Gordon EJ, Caicedo JC. Ethnic advantages in kidney transplant outcomes: the Hispanic Paradox at work? Nephrol Dial Transplant 2008;24(4):1103–1109. DOI: 10.1093/ndt/gfn691.
  11. Patel MI, Schupp CW, et al. How do social factors explain outcomes in non-small-cell lung cancer among Hispanics in California? Explaining the Hispanic Paradox. J Clin Oncol 2013;31(28):3572–3578. DOI: 10.1200/JCO.2012.48.6217.
  12. Morris T, Gomez A, et al. Paradox lost on the U.S.-Mexico border: U.S. Latinas and cesarean rates. BMC Pregnancy Childbirth 2018;18(1):82. DOI: 10.1186/s12884-018-1701-9.
  13. González-Quintero VH, Tolaymat L, et al. Outcome of pregnancies among Hispanics: revisiting the epidemiologic paradox. J Reprod Med 2006;51(1):10–14.
  14. Overton TL, Phillips JL, et al. The Hispanic Paradox: does it exist in the injured? Am J Surg 2015;210(5):827–832. DOI: 10.1016/j. amjsurg.2015.05.019.
  15. Zogg CK, Olufajo OA, et al. The need to consider longer-term outcomes of care: racial/ethnic disparities among adult and older adult emergency general surgery patients at 30, 90, and 180 days. Ann Surg 2017;266(1):66–75. DOI: 10.1097/SLA.0000000000001932.
  16. Zogg CK, Jiang W, et al. Racial/ethnic disparities in longer-term outcomes among emergency general surgery patients: the unique experience of older adults. Ann Surg 2018;268(6):968–979. DOI: 10.1097/SLA.0000000000002449
  17. Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Overview of the State Inpatient Databases (SID).
  18. Accessed 15 July 2018. Available from: https://www.hcup-us. ahrq.gov/sidoverview.jsp.
  19. Shafi S, Aboutanos MB, et al. Emergency general surgery: definition and estimated burden of disease. J Trauma Acute Care Surg 2013;74(4):1092–1097. DOI: 10.1097/TA.0b013e31827e1bc7.
  20. Shah AA, Haider AH, et al. National estimates of predictors of outcomes for emergency general surgery. J Trauma Acute Care Surg 2015;78(3):482–491. DOI: 10.1097/TA.0000000000000555.
  21. Scott JW, Olufajo OA, et al. Use of national burden to define operative emergency general surgery. JAMA Surg 2016;151(6):e160480. DOI: 10.1001/jamasurg.2016.0480.
  22. American Hospital Association. AHA Annual Survey Database. 2018. Accessed 15 July 2018. Available from: https://www.ahadataviewer. com/additional-data-products/AHA-Survey/
  23. Torain MJ, Maragh-Bass AC, et al. Surgical disparities: a comprehensive review and new conceptual framework. J Am Coll Surg 2016;223(2):408–418. DOI: 10.1016/j.jamcollsurg.2016.04.047.
  24. Haider AH, Dankwa-Mullan I, et al. Setting a nationla agenda for surgical disparities research: Recommendations from the National Institutes of Health and American College of Surgeons Summit. JAMA Surg 2016;151(6):554–563. DOI: 10.1001/jamasurg.2016.0014.
  25. Zogg CK, Jiang W, et al. Racial disparities in emergency general surgery: do differences in outcomes persist among universally insured military patients? J Trauma Acute Care Surg 2016;80(5): 764–775. DOI: 10.1097/TA.0000000000001004.
  26. Ramirez M, Chang DC, et al. Can universal coverage eliminate health disparities? Reversal of disparate injury outcomes in elderly insured minorities. J Surg Res 2013;182(2):264–269. DOI: 10.1016/j. jss.2012.01.032.
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