Surgical care for African, Caribbean, and Black communities in high-income universal healthcare countries: A scoping review focused on access and quality indicators

Introduction: African, Caribbean, and Black (ACB) populations experience disparities in access to and quality of surgical care, but most existing research is from the United States (U.S.), limiting the generalizability to countries with universal healthcare systems. The experiences of inequities for ACB populations in access to and quality of surgical care are increasingly recognized. However, existing evidence remains fragmented and not well characterized in current research, highlighting the need for examination of the evidence. Objective: This scoping review aims to synthesize the literature on access and quality indicators of surgical care among adult ACB populations in high-income countries with universal healthcare and identify evidence gaps. Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search of multiple databases and grey literature sources was completed, with studies eligible for inclusion if published from database inception to April 2025. Eligible studies reported on surgical access and/or quality outcomes stratified by adult ACB in high-income countries with universal healthcare. Titles and abstracts were screened by two independent reviewers, and those that met the screening criteria were reviewed in full. Data from included studies were charted using a standardized form informed by the Surgical Disparities and PROGRESS-Plus frameworks. To address heterogeneity across study designs, outcomes were categorized by direction of effect, defined as whether findings indicated worse, better, or no difference for ACB populations in relation to comparator groups. Results: Of the 19,182 unique references identified by the search, 29 original studies were included. Three of 29 studies provided a rationale for how ACB groups were aggregated or disaggregated. Commonly reported outcomes included mortality, complications, and wait times. ACB patients often had longer wait times and worse postoperative outcomes. Significant gaps were found in access outcomes, patient-centred outcomes, and there was no qualitative data capturing ACB patient experiences. Discussion: The findings reveal gaps in understanding structural, cultural, and patient-centred factors influencing access to and quality of surgical care for ACB populations. Key challenges include methodological limitations, specifically transparency and data stratification which often includes oversimplified racial/ethnic categories, and reliance on administrative datasets that overlook contextual factors shaping surgical experiences. Future research should collect and analyse disaggregated racial/ethnic data to examine within group differences when possible and increase transparency in reporting methods and approaches. In parallel, qualitative exploration of patient and provider experiences, and research studies that incorporate end-users in identifying and prioritizing relevant outcomes are needed to meaningfully advance equity in surgical care research.