Racial/ethnic differences in receipt of surgery among children in the United States

  • Ethan L. Sanford
    Corresponding author at: 1935 Medical District Drive, Dallas, Texas 75235.
    Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX, USA

    Department of Pediatric Critical Care, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, Texas, USA

    Outcomes Research Consortium, Cleveland, OH, USA
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  • Rasmi Nair
    Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
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  • Adam Alder
    Department of Pediatric Surgery, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX, USA
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  • Daniel I. Sessler
    Outcomes Research Consortium, Cleveland, OH, USA

    Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
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  • Glenn Flores
    Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA

    Holtz Children's Hospital, Jackson Health System, Miami, FL, USA
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  • Peter Szmuk
    Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX, USA

    Outcomes Research Consortium, Cleveland, OH, USA
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      • What is currently known about this topic?
      • Racial disparities in outcomes of pediatric surgery have been previously documented; however, differences in receipt of pediatric surgical care in the United States have not been analyzed.
      • What new information is contained in this article?
      • Among children less than 19 years old, analysis from a large, national survey of health reveals an association between minority race/ethnicity and decreased odds of receiving surgery despite adjustment for relevant covariates.



      It is unknown whether racial/ethnic disparities exist in surgical utilization for children. The aim, therefore, was to evaluate the odds of surgery among children in the US by race/ethnicity to test the hypothesis that minority children have less surgery.


      Cross-sectional data were analyzed on children 0–18 years old from the 1999 to 2018 National Health Interview Survey, a large, nationally representative survey. The primary outcome was odds of surgery in the prior 12 months for non Latino African-American, Asian, and Latino children, compared with non Latino White children, after adjustment for relevant covariates. The National Surgical Quality Improvement Program Pediatric Dataset was used to analyze the odds of emergent/urgent surgery by race/ethnicity.


      Data for 219,098 children were analyzed, of whom 10,644 (4.9%) received surgery. After adjustment for relevant covariates, African-American (AOR, 0.54; 95% CI, 0.50–0.59), Asian (AOR, 0.39; 95% CI, 0.33–0.46), and Latino (AOR, 0.62; 95% CI, 0.57–0.67) children had lower odds of surgery than White children. Latino children were more likely to require emergent or urgent surgery (AOR, 1.71; 95% CI, 1.68–1.74).


      Latino, African-American, and Asian children have significantly lower adjusted odds of having surgery than White children in America, and Latino children were more likely to have emergent or urgent surgery. These racial/ethnic differences in surgery may reflect disparities in healthcare access which should be addressed through further research, ongoing monitoring, targeted interventions, and quality-improvement efforts.

      Level of evidence


      Type of study

      Prognosis study.



      NHIS (the National Health Interview Survey), NSQIP (National Surgical Quality Improvement Program)
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