Tags

Type your tag names separated by a space and hit enter

Downwardly mobile: the accidental cost of being uninsured.
Arch Surg. 2009 Nov; 144(11):1006-11.AS

Abstract

HYPOTHESIS

Given the pervasive evidence of disparities in screening, hospital admission, treatment, and outcomes due to insurance status, a disparity in outcomes in trauma patients (in-hospital death) among the uninsured may exist, despite preventive regulations (such as the Emergency Medical Treatment and Active Labor Act).

DESIGN

Data were collected from the National Trauma Data Bank from January 1, 2002, through December 31, 2006 (version 7.0). We used multiple logistic regression to compare mortality rates by insurance status.

SETTING

The National Trauma Data Bank contains information from 2.7 million patients admitted for traumatic injury to more than 900 US trauma centers, including demographic data, medical history, injury severity, outcomes, and charges.

PATIENTS

Data from patients (age, >or=18 years; n = 687 091) with similar age, race, injury severity, sex, and injury mechanism were evaluated for differences in mortality by payer status.

MAIN OUTCOME MEASURE

In-hospital death after blunt or penetrating traumatic injury.

RESULTS

Crude analysis revealed a higher mortality for uninsured patients (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.36-1.42; P < .001). Controlling for sex, race, age, Injury Severity Score, Revised Trauma Score, and injury mechanism (adjusted for clustering on hospital), uninsured patients had the highest mortality (OR, 1.80; 95% CI, 1.61-2.02; P < .001). Subgroup analysis of young patients unlikely to have comorbidities revealed higher mortality for uninsured patients (OR, 1.89; 95% CI, 1.66-2.15; P < .001), as did subgroup analyses of patients with head injuries (OR, 1.65; 95% CI, 1.42-1.90; P < .001) and patients with 1 or more comorbidities (OR, 1.52; 95% CI, 1.30-1.78; P < .001).

CONCLUSIONS

Uninsured Americans have a higher adjusted mortality rate after trauma. Treatment delay, different care (via receipt of fewer diagnostic tests), and decreased health literacy are possible mechanisms.

Authors+Show Affiliations

Department of Plastic and Oral Surgery, Children's Hospital Boston; Department of Plastic and Oral Surgery, Harvard Medical School, Boston, Massachusetts, USA. heather.rosen@childrens.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19917936

Citation

Rosen, Heather, et al. "Downwardly Mobile: the Accidental Cost of Being Uninsured." Archives of Surgery (Chicago, Ill. : 1960), vol. 144, no. 11, 2009, pp. 1006-11.
Rosen H, Saleh F, Lipsitz S, et al. Downwardly mobile: the accidental cost of being uninsured. Arch Surg. 2009;144(11):1006-11.
Rosen, H., Saleh, F., Lipsitz, S., Rogers, S. O., & Gawande, A. A. (2009). Downwardly mobile: the accidental cost of being uninsured. Archives of Surgery (Chicago, Ill. : 1960), 144(11), 1006-11. https://doi.org/10.1001/archsurg.2009.195
Rosen H, et al. Downwardly Mobile: the Accidental Cost of Being Uninsured. Arch Surg. 2009;144(11):1006-11. PubMed PMID: 19917936.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Downwardly mobile: the accidental cost of being uninsured. AU - Rosen,Heather, AU - Saleh,Fady, AU - Lipsitz,Stuart, AU - Rogers,Selwyn O,Jr AU - Gawande,Atul A, PY - 2009/11/18/entrez PY - 2009/11/18/pubmed PY - 2010/1/6/medline SP - 1006 EP - 11 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 144 IS - 11 N2 - HYPOTHESIS: Given the pervasive evidence of disparities in screening, hospital admission, treatment, and outcomes due to insurance status, a disparity in outcomes in trauma patients (in-hospital death) among the uninsured may exist, despite preventive regulations (such as the Emergency Medical Treatment and Active Labor Act). DESIGN: Data were collected from the National Trauma Data Bank from January 1, 2002, through December 31, 2006 (version 7.0). We used multiple logistic regression to compare mortality rates by insurance status. SETTING: The National Trauma Data Bank contains information from 2.7 million patients admitted for traumatic injury to more than 900 US trauma centers, including demographic data, medical history, injury severity, outcomes, and charges. PATIENTS: Data from patients (age, >or=18 years; n = 687 091) with similar age, race, injury severity, sex, and injury mechanism were evaluated for differences in mortality by payer status. MAIN OUTCOME MEASURE: In-hospital death after blunt or penetrating traumatic injury. RESULTS: Crude analysis revealed a higher mortality for uninsured patients (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.36-1.42; P < .001). Controlling for sex, race, age, Injury Severity Score, Revised Trauma Score, and injury mechanism (adjusted for clustering on hospital), uninsured patients had the highest mortality (OR, 1.80; 95% CI, 1.61-2.02; P < .001). Subgroup analysis of young patients unlikely to have comorbidities revealed higher mortality for uninsured patients (OR, 1.89; 95% CI, 1.66-2.15; P < .001), as did subgroup analyses of patients with head injuries (OR, 1.65; 95% CI, 1.42-1.90; P < .001) and patients with 1 or more comorbidities (OR, 1.52; 95% CI, 1.30-1.78; P < .001). CONCLUSIONS: Uninsured Americans have a higher adjusted mortality rate after trauma. Treatment delay, different care (via receipt of fewer diagnostic tests), and decreased health literacy are possible mechanisms. SN - 1538-3644 UR - https://www.unboundmedicine.com/medline/citation/19917936/Downwardly_mobile:_the_accidental_cost_of_being_uninsured_ L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.2009.195 DB - PRIME DP - Unbound Medicine ER -