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Race and insurance status as risk factors for trauma mortality.
Arch Surg. 2008 Oct; 143(10):945-9.AS

Abstract

OBJECTIVE

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

METHODS

Review of patients (aged 18-64 years; Injury Severity Score > or = 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.

Authors+Show Affiliations

Department of Surgery, Division of Trauma, Johns Hopkins Hospital, 600 N Wolfe St, Blalock 688, Baltimore, MD 21287, USA. ahaider1@jhmi.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18936372

Citation

Haider, Adil H., et al. "Race and Insurance Status as Risk Factors for Trauma Mortality." Archives of Surgery (Chicago, Ill. : 1960), vol. 143, no. 10, 2008, pp. 945-9.
Haider AH, Chang DC, Efron DT, et al. Race and insurance status as risk factors for trauma mortality. Arch Surg. 2008;143(10):945-9.
Haider, A. H., Chang, D. C., Efron, D. T., Haut, E. R., Crandall, M., & Cornwell, E. E. (2008). Race and insurance status as risk factors for trauma mortality. Archives of Surgery (Chicago, Ill. : 1960), 143(10), 945-9. https://doi.org/10.1001/archsurg.143.10.945
Haider AH, et al. Race and Insurance Status as Risk Factors for Trauma Mortality. Arch Surg. 2008;143(10):945-9. PubMed PMID: 18936372.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Race and insurance status as risk factors for trauma mortality. AU - Haider,Adil H, AU - Chang,David C, AU - Efron,David T, AU - Haut,Elliott R, AU - Crandall,Marie, AU - Cornwell,Edward E,3rd PY - 2008/10/22/pubmed PY - 2008/12/17/medline PY - 2008/10/22/entrez SP - 945 EP - 9 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 143 IS - 10 N2 - OBJECTIVE: To determine the effect of race and insurance status on trauma mortality. METHODS: Review of patients (aged 18-64 years; Injury Severity Score > or = 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. SN - 1538-3644 UR - https://www.unboundmedicine.com/medline/citation/18936372/Race_and_insurance_status_as_risk_factors_for_trauma_mortality_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.143.10.945 DB - PRIME DP - Unbound Medicine ER -