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Does insurance status matter at a public, level I trauma center?
J Trauma. 2010 Jan; 68(1):211-6.JT

Abstract

BACKGROUND

It has previously been demonstrated that a lack of insurance impedes access to health care services and may affect outcome after acute medical events. Very little data exists on the impact of insurance status on outcomes after traumatic injury. The purpose of this study was to determine whether insurance status has an impact on the outcomes of trauma patients admitted to a publicly funded county level I trauma center.

PATIENTS

This is a retrospective study of adult trauma patients (aged 18 years or older) admitted between January 1,1998, and December 31, 2005. Patients transferred out within 1 week of injury were excluded. Variables examined included demographics, insurance status, mechanism of injury, Injury Severity Score, Abbreviated Injury Scales, Glasgow Coma Scale, procedures performed, and outcomes. Logistic regression was used to determine independent risk factors for mortality.

RESULTS

Sixty-eight percent of the 29,829 patients admitted were uninsured. Uninsured patients were younger (36 versus 41, p < 0.0001) and less severely injured (Injury Severity Score 8 versus 10, p < 0.0001) but had a significantly higher mortality rate (7.0% versus 4.9%, p < 0.0001) compared with insured counterparts. Logistic regression identified uninsured status as an independent risk factor for mortality (AOR, 3.4; 95% confidence interval, 2.9-4.1; p < 0.0001). There was significant disparity between the mortality rates for uninsured and insured patients within the Black (7.1% versus 3.3%, p < 0.0001) and Hispanic (6.5% versus 4.1%, p < 0.0001) populations. No such mortality difference was observed in the white (7.2% versus 6.9%, p = 0.7) and Asian (9.7% versus 9.2%, p = 0.8) populations.

CONCLUSION

Despite being younger and less severely injured, uninsured trauma patients had a significantly higher mortality rate. The etiology of this discrepancy is unclear and warrants further investigation.

Authors+Show Affiliations

Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite 8215N, Los Angeles, CA 90048, USA. ali.salim@cshs.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20065777

Citation

Salim, Ali, et al. "Does Insurance Status Matter at a Public, Level I Trauma Center?" The Journal of Trauma, vol. 68, no. 1, 2010, pp. 211-6.
Salim A, Ottochian M, DuBose J, et al. Does insurance status matter at a public, level I trauma center? J Trauma. 2010;68(1):211-6.
Salim, A., Ottochian, M., DuBose, J., Inaba, K., Teixeira, P., Chan, L. S., & Margulies, D. R. (2010). Does insurance status matter at a public, level I trauma center? The Journal of Trauma, 68(1), 211-6. https://doi.org/10.1097/TA.0b013e3181a0e659
Salim A, et al. Does Insurance Status Matter at a Public, Level I Trauma Center. J Trauma. 2010;68(1):211-6. PubMed PMID: 20065777.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does insurance status matter at a public, level I trauma center? AU - Salim,Ali, AU - Ottochian,Marcus, AU - DuBose,Joseph, AU - Inaba,Kenji, AU - Teixeira,Pedro, AU - Chan,Linda S, AU - Margulies,Daniel R, PY - 2010/1/13/entrez PY - 2010/1/13/pubmed PY - 2010/1/29/medline SP - 211 EP - 6 JF - The Journal of trauma JO - J Trauma VL - 68 IS - 1 N2 - BACKGROUND: It has previously been demonstrated that a lack of insurance impedes access to health care services and may affect outcome after acute medical events. Very little data exists on the impact of insurance status on outcomes after traumatic injury. The purpose of this study was to determine whether insurance status has an impact on the outcomes of trauma patients admitted to a publicly funded county level I trauma center. PATIENTS: This is a retrospective study of adult trauma patients (aged 18 years or older) admitted between January 1,1998, and December 31, 2005. Patients transferred out within 1 week of injury were excluded. Variables examined included demographics, insurance status, mechanism of injury, Injury Severity Score, Abbreviated Injury Scales, Glasgow Coma Scale, procedures performed, and outcomes. Logistic regression was used to determine independent risk factors for mortality. RESULTS: Sixty-eight percent of the 29,829 patients admitted were uninsured. Uninsured patients were younger (36 versus 41, p < 0.0001) and less severely injured (Injury Severity Score 8 versus 10, p < 0.0001) but had a significantly higher mortality rate (7.0% versus 4.9%, p < 0.0001) compared with insured counterparts. Logistic regression identified uninsured status as an independent risk factor for mortality (AOR, 3.4; 95% confidence interval, 2.9-4.1; p < 0.0001). There was significant disparity between the mortality rates for uninsured and insured patients within the Black (7.1% versus 3.3%, p < 0.0001) and Hispanic (6.5% versus 4.1%, p < 0.0001) populations. No such mortality difference was observed in the white (7.2% versus 6.9%, p = 0.7) and Asian (9.7% versus 9.2%, p = 0.8) populations. CONCLUSION: Despite being younger and less severely injured, uninsured trauma patients had a significantly higher mortality rate. The etiology of this discrepancy is unclear and warrants further investigation. SN - 1529-8809 UR - https://www.unboundmedicine.com/medline/citation/20065777/Does_insurance_status_matter_at_a_public_level_I_trauma_center L2 - https://doi.org/10.1097/TA.0b013e3181a0e659 DB - PRIME DP - Unbound Medicine ER -