Race, Ethnicity, and Source of Payment Can Increase Patient Risk of Adverse Events in Hospitals

June 7, 2023

Washington, D.C. (June 7, 2023)—The Leapfrog Group, a national nonprofit advancing the highest standards for patient safety in hospitals and ambulatory surgery centers, today published a report examining the association between Leapfrog Hospital Safety Grades and differences in rates of adverse safety events among white, Black, and Hispanic patients and among patients with commercial insurance and public insurance such as Medicare or Medicaid. The analysis found that higher-graded hospitals are safer for all patients, but Black and Hispanic patients are still at increased risk of experiencing certain surgery-related adverse safety events when compared to white patients even at hospitals at all grade levels. The report, Racial, Ethnic and Payer Disparities in Adverse Safety Events: Are there Differences across Leapfrog Hospital Safety Grades, was developed in partnership with Urban Institute, with funding from AARP.

“We must honestly acknowledge the persistent racial and ethnic disparities, but we can't stop there,” said Missy Danforth, vice president of health care ratings at The Leapfrog Group. “Achieving safe care for all patients requires a focused commitment to transparency, better data collection, and targeted interventions.”

The report compares the rate of 11 dangerous, preventable patient safety problems, including blood clots or sepsis after surgery, among white, Black, and Hispanic patients at hospitals that earned Hospital Safety Grades of “A,” “B,” and “C/D/F.” Analyzing differences across all graded hospitals, Black patients experience a higher incidence of surgery-related complications than white patients, including:

  • 34% higher rates of sepsis after surgery
  • 51% higher rates of dangerous blood clots after surgery
  • 17% higher rates of respiratory failure after surgery

Additionally, relative to white patients and across all Hospital Safety Grades, Black patients have a significantly higher risk of Stage 3 and 4 pressure ulcers, which are bed sores that progressed to a stage that is debilitating or deadly. Relative to white patients, Hispanic patients have a higher risk of experiencing sepsis and respiratory failure after surgery, and these differences remain significant at higher-graded hospitals.

  • 34% higher rates of sepsis after surgery
  • 21% higher rates of respiratory failure after surgery

Across all hospitals, patients covered by Medicare or Medicaid experienced higher rates of adverse safety events when compared to patients covered by private insurance coverage. 

“These data suggest that the issue does not lie in the individual hospitals themselves but is a systemic issue impacting the quality of care for Black and Hispanic patients and those with public insurance plans,” said Anuj Gangopadhyaya senior research associate in the Health Policy Center at the Urban Institute. “Hospitals should recognize these disparities and ensure resources are devoted to reducing adverse safety events among patient groups at the highest risk.”

The report found that the Hospital Safety Grade accurately predicted which hospitals put patients most at risk for adverse events. However, for Black or Hispanic patients, or patients without private insurance, the risks were higher in each grade category. Data used in this report was derived from 2019 hospital discharge data from 15 states, including over 10 million patient records, made available through a database maintained by the federal Agency for Healthcare Research & Quality (AHRQ).  Rates were adjusted for patient age, sex, state, quartile of income based on patient zip code and payer type. The Leapfrog Hospital Safety Grade is a letter grade Leapfrog assigns twice per year to every general hospital rating patient risk of medical errors, injuries, accidents, and infections. The Grade is comprised of up to 30 evidence-based measures, with a transparent methodology advised by a national expert panel. AHRQ does not permit public reporting by database, but researchers were able to analyze data by graded hospitals to derive findings. To learn more about the report, visit https://www.leapfroggroup.org/racial-ethnic-and-payer-disparities-adverse-safety-events-are-there-differences-across-leapfrog.


About The Leapfrog Group

Founded in 2000 by large employers and other purchasers, The Leapfrog Group is a national nonprofit organization driving a movement for giant leaps for patient safety. The Leapfrog Hospital Safety Grade assigns letter grades to hospitals based on their record of patient safety, helping consumers protect themselves and their families from errors, injuries, accidents, and infections. For more, follow us on Twitter and Facebook, and sign up for our newsletter.


About The Urban Institute

The Urban Institute is a nonprofit research organization that provides data and evidence to help advance upward mobility and equity. We are a trusted source for changemakers who seek to strengthen decision-making, create inclusive economic growth, and improve the well-being of families and communities. For more than 50 years, Urban has delivered facts that inspire solutions—and this remains our charge today.


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