Fact Sheet: The Sad Truth About Hospitals, Patient Safety And Racism

Friday, July 23, 2021



Prior studies have shown differences in the quality of hospitals that Black patients tend to be admitted to relative to white patients. But a new study from the Urban Institute (UI) takes the racial analysis a step further and “sets out to assess whether Black and white patients experience different patient safety risks in the same hospital[1] (emphasis added).

UI examined 11 standard patient safety indicators related to hospital-acquired illnesses and injuries and found significant differences in the quality of care delivered to Black and white patients within the same hospital.

Black Patients Are More Likely Than White Patients to Receive Unsafe Care 

  • “For 6 out of 11 patient safety indicators, including 4 out of 7 surgery-related patient safety indicators, Black adult patients experienced significantly worse patient safety relative to white patients in the same age group, of the same gender, and treated in the same hospital.”[2]

  • Surgery-related care was the most problematic: “Black patients systematically experience higher rates of hospital-acquired illnesses or injuries related to surgical procedures relative to white patients treated in the same hospital.”

  • “Relative to white patients, Black patients had significantly higher rates of post- or perioperative hemorrhage, acute kidney injury requiring dialysis, respiratory failure, pulmonary embolism or deep vein thrombosis, and sepsis.”

Racial Disparities Exist Irrespective of a Patient’s Insurance

  • “Black-white patient safety disparities persist even when patients have similar types of coverage,” i.e., Medicare, Medicaid or private insurance.

  • “Adjusting for patient insurance coverage type had little effect on the estimated differences in patient safety risks between Black and white adult patients admitted to the same hospital.” 

Racial Disparities Exist Regardless of the Percentage of Black vs. White Patients

  • “Black patients endure higher rates of adverse patient safety events relative to white patients irrespective of how many Black patients their hospital treats.”

  • “When separating hospitals into those in which more than 25 percent of patients are Black and all other hospitals, we find that Black adult patients experienced higher within-hospital adverse patient safety events relative to white patients in both groups of hospitals.” 

  • “[A]mong surgery-related patient safety indicators, Black patients experienced higher rates of adverse patient safety events relative to white patients both in hospitals where Black patients represent larger and smaller shares of the hospital’s patient population.”

Racial Disparities Exist Irrespective of a Hospital’s Resources

  • “Across both low- and high-resourced hospitals, [UI observed] Black-white differences in patient safety that are in the same direction as in the main analysis.”

  • “Even at the same high-resourced hospitals that treat more private patients as a share of all patients, Black patients continue to experience higher rates of adverse safety events surrounding surgical procedures relative to white patients.” 

  • UI “found no evidence that high-resourced hospitals, as proxied by the share of patients with private insurance coverage, had markedly better outcomes for Black patients relative to white patients.”


[1] Anuj Gangopadhyaya, “Do Black and White Patients Experience Similar Rates of Adverse Safety Events at the Same Hospital?” Urban Institute (July 2021), https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2021/rwjf465933

[2] By contrast, “[w]hite patients experienced significantly worse quality of care relative to Black patients in the same hospital on 2 patient safety indicators. When admitted to the same hospital, quality of care was similar for Black and white patients on 3 out of 11 patient safety indicators.”

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