 |
 |

Race and Insurance Status as Risk Factors for Trauma Mortality
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).
CiteULike Connotea Delicious Digg Facebook Reddit Technorati Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
 |
Ethnicity, Insurance Status, and Hospitals Serving Predominantly Minorities: Comment on "Association Between Hospitals Caring for a Disproportionately High Percentage of Minority Patients With Trauma and Increased Mortality Due to Trauma"
Salim
Arch Surg 2012;147:70-70.
FULL TEXT
Association Between Hospitals Caring for a Disproportionately High Percentage of Minority Trauma Patients and Increased Mortality: A Nationwide Analysis of 434 Hospitals
Haider et al.
Arch Surg 2012;147:63-70.
ABSTRACT
| FULL TEXT
Limb Outcome and Mortality in Lower and Upper Extremity Arterial Injury: A Comparison Using the National Trauma Data Bank
Tan et al.
VASC ENDOVASCULAR SURG 2011;45:592-597.
ABSTRACT
Hospitalization admission rates for low-income subjects with full health insurance coverage in France
Tuppin et al.
Eur J Public Health 2011;21:560-566.
ABSTRACT
| FULL TEXT
The Effect of Insurance Status on Mortality and Procedural Use in Critically Ill Patients
Lyon et al.
Am. J. Respir. Crit. Care Med. 2011;184:809-815.
ABSTRACT
| FULL TEXT
Association of Unconscious Race and Social Class Bias With Vignette-Based Clinical Assessments by Medical Students
Haider et al.
JAMA 2011;306:942-951.
ABSTRACT
| FULL TEXT
Massachusetts' Health Care Reform Increased Access To Care For Hispanics, But Disparities Remain
Maxwell et al.
Health Aff (Millwood) 2011;30:1451-1460.
ABSTRACT
| FULL TEXT
Electronic Health Records vs Medicaid Claims: Completeness of Diabetes Preventive Care Data in Community Health Centers
DeVoe et al.
Ann Fam Med 2011;9:351-358.
ABSTRACT
| FULL TEXT
Barriers to Evaluation and Wait Listing for Kidney Transplantation
Schold et al.
CJASN 2011;6:1760-1767.
ABSTRACT
| FULL TEXT
Effect of Race and Socioeconomic Status in the Treatment of Appendicitis in Patients With Equal Health Care Access
Lee et al.
Arch Surg 2011;146:156-161.
ABSTRACT
| FULL TEXT
Possible Geographical Barriers to Trauma Center Access for Vulnerable Patients in the United States: An Analysis of Urban and Rural Communities
Hsia and Shen
Arch Surg 2011;146:46-52.
ABSTRACT
| FULL TEXT
The mean does not mean as much anymore: finding sub-groups for tailored therapeutics
Ruberg et al.
Clin Trials 2010;7:574-583.
ABSTRACT
Disparities in Emergency Trauma Care: Really So "Downwardly"?
White and Zwemer
Arch Surg 2010;145:603-604.
FULL TEXT
Downwardly Mobile: The Accidental Cost of Being Uninsured
Rosen et al.
Arch Surg 2009;144:1006-1011.
ABSTRACT
| FULL TEXT
|