Health care disparity exists among those undergoing emergent hernia repairs in New York State

Introduction: Socioeconomic factors predispose certain populations to an increased exposure to emergent operative procedures. The aim of this study is to evaluate the role socioeconomic factors play in emergent repairs of inguinal, ventral and umbilical hernias. Methods: The SPARCS database was used to identify all patients undergoing emergent ventral hernia repair (EVR), emergent inguinal hernia repair (EIR), and emergent umbilical hernia repair (EUR) between 2008 and 2015. Chi-square test with exact p values from Monte Carlo simulation determined marginal associations between repairs (elective vs. emergent), and patient characteristics and comorbidities. Multivariable logistic regression models were further utilized to examine socioeconomic disparity. Results: 107,887 ventral hernias, 66,947 inguinal hernias, and 63,515 umbilical hernias (total 238,349) were noted. African Americans were most likely to undergo an EVR compared to Caucasians (OR 1.55, 95% CI: 1.48–1.61), Asians (OR 1.31, 95% CI: 1.15–1.5), and Hispanics (OR 1.3, 95% CI: 1.23–1.37). African Americans were most likely to undergo EIR compared to Caucasians (OR 2.2, 95% CI: 2.06–2.36), Asians (OR 1.74, 95% CI: 1.49–2.02), and Hispanics (OR 1.22, 95% CI: 1.12–1.34). African Americans were most likely to undergo EUR compared to whites (OR 1.29, 95% CI: 1.22–1.36), Asians (26.62%, OR 1.21, 95% CI: 1.01–1.46) and Hispanic (28.03%, OR 1.08, 95% CI: 1.01–1.16). Medicaid patients were also more likely to undergo EVR (OR 1.31, OR 1.73), EIR (OR 2.92, OR 4.55) and EUR (OR 1.63, OR 2.31) compared to Medicare and commercial insurance. Conclusion: Race is a contributing factor in who undergoes an emergent hernia repair in New York State. A significantly larger proportion of the African American population is undergoing hernia repair in the emergent setting. Socioeconomic status, as indicated by the significant number of Medicaid patients undergoing emergent hernia repairs, also plays a role.