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Adil H. Haider, MD, MPH; David C. Chang, MPH, MBA, PhD; David T. Efron, MD; Elliott R. Haut, MD; Marie Crandall, MD, MPH; Edward E. Cornwell III, MD

Arch Surg. 2008;143(10):945-949.

Objective  To determine the effect of race and insurance status on trauma mortality.

Methods  Review of patients (aged 18-64 years; Injury Severity Score  9) included in the National Trauma Data Bank (2001-2005). African American and Hispanic patients were each compared with white patients and insured patients were compared with uninsured patients. Multiple logistic regression analyses determined differences in survival rates after adjusting for demographics, injury severity (Injury Severity Score and revised Trauma Score), severity of head and/or extremity injury, and injury mechanism.

Results  A total of 429 751 patients met inclusion criteria. African American (n = 72 249) and Hispanic (n = 41 770) patients were less likely to be insured and more likely to sustain penetrating trauma than white patients (n = 262 878). African American and Hispanic patients had higher unadjusted mortality rates (white, 5.7%; African American, 8.2%; Hispanic, 9.1%; P = .05 for African American and Hispanic patients) and an increased adjusted odds ratio (OR) of death compared with white patients (African American OR, 1.17; 95% confidence interval [CI], 1.10-1.23; Hispanic OR, 1.47; 95% CI, 1.39-1.57). Insured patients (47%) had lower crude mortality rates than uninsured patients (4.4% vs 8.6%; P = .05). Insured African American and Hispanic patients had increased mortality rates compared with insured white patients. This effect worsened for uninsured patients across groups (insured African American OR, 1.2; 95% CI, 1.08-1.33; insured Hispanic OR, 1.51; 95% CI, 1.36-1.64; uninsured white OR, 1.55; 95% CI, 1.46-1.64; uninsured African American OR, 1.78; 95% CI, 1.65-1.90; uninsured Hispanic OR, 2.30; 95% CI, 2.13-2.49). The reference group was insured white patients.

Conclusion  Race and insurance status each independently predicts outcome disparities after trauma. African American, Hispanic, and uninsured patients have worse outcomes, but insurance status appears to have the stronger association with mortality after trauma.

Author Affiliations: Departments of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland (Drs Haider, Chang, Efron, and Haut); Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Dr Crandall) Howard University College of Medicine, Washington, DC (Dr Cornwell).

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