Racial disparity among Native Americans in coronary artery bypass grafting: An analysis of national inpatient sample from 2015 to 2020.

Abstract

Background: Disparities have been shown in the outcomes of coronary artery bypass grafting (CABG) in racial minorities. Although Native Americans are known to have a higher risk for cardiovascular diseases, the current literature on CABG outcomes for Native Americans remains notably limited, probably due to their limited population size. Thus, this study aimed to investigate racial disparities in CABG outcomes among Native Americans.

Methods: Patients who underwent CABG were identified in National Inpatient Sample database from last quarter of 2015 to 2020. A 1:2 propensity score matching was conducted between Native Americans and Caucasians to address preoperative differences in demographics, socioeconomic status, comorbidity, and hospital characteristics. In-hospital outcomes, length of stay (LOS), time from admission to operation, and total hospital charge were compared.

Results: There were 905 (0.54 %) Native Americans and 125,983 (74.91 %) Caucasians, where 1,838 Caucasians were matched to all the Native Americans. The in-hospital mortality rate was elevated in Native Americans but was not statistically different (2.87 % vs. 2.23 %, p = 0.43). However, Native Americans had a higher risk of cardiogenic shock (8.51 % vs. 6.2 %, p = 0.03). There was no difference in time from admission to operation (2.55 ± 0.11 vs. 2.73 ± 0.08 days, p = 0.20), LOS (9.82 ± 0.23 vs. 9.95 ± 0.20 days, p = 0.65), or the total hospital charge between the two groups (205,594 ± 5192.8 vs. 213,961 ± 4150.9 US dollars, p = 0.20).

Conclusion: Native Americans had a significantly higher risk of cardiogenic shock after CABG. However, in-house mortality and other parameters were not affected. These disparities highlight challenges that Native Americans encounter and emphasize the need for targeted interventions to ensure health equity.