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Insurance-and race-related disparities decrease in elderly trauma patients.
J Trauma Acute Care Surg. 2013 Jan; 74(1):312-6.JT

Abstract

BACKGROUND

Little focus is on health care disparities in the elderly, a population largely covered by public insurance. We characterized insurance type and race in elderly trauma patients to determine if lack of insurance or minority status predict increased mortality.

METHODS

The National Trauma Data Bank (version 7.0) was queried for all adult blunt trauma patients. We divided patients into two cohorts (15-64 or ≥ 65 years) based on age for universal Medicare eligibility. Our primary outcome measure was in-hospital mortality. Multiple logistic regression was used to control for confounding variables.

RESULTS

A total of 541,471 patients met inclusion criteria. Among younger patients, the most common insurance type was private (41.0%), with 26.9% uninsured. In contrast, the most common insurance type among older patients was Medicare (64.6%), with 6.0% uninsured. Within the younger cohort, private insurance (adjusted odds ratio [AOR], 0.6; p < 0.01) and other insurance (AOR, 0.8; p < 0.01) predicted reduced mortality, while Medicare predicted similar mortality (AOR, 1.1; p = 0.18) compared with no insurance. Black race (AOR, 1.4; p < 0.01) and Hispanic ethnicity (AOR, 1.4; p < 0.01) predicted higher mortality compared with white race. Within the older cohort, no insurance predicted similar mortality as Medicare (AOR, 1.0; p = 0.43), private insurance (AOR, 1.0; p = 0.51), and other insurance (AOR, 1.0; p = 0.71). Hispanic ethnicity predicted increased mortality (AOR, 1.4; p < 0.01), while Asian race was protective (AOR, 0.7; p = 0.01) compared with white race.

CONCLUSION

Elderly trauma patients present primarily with Medicare, while younger trauma patients are mostly privately insured; elderly patients are four times more likely to be insured. Disparities caused by lack of insurance and minority race are reduced in elderly trauma patients.

LEVEL OF EVIDENCE

Epidemiologic/prognostic study, level III.

Authors+Show Affiliations

Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.No affiliation info availableNo 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

23147178

Citation

Singer, Matthew B., et al. "Insurance-and Race-related Disparities Decrease in Elderly Trauma Patients." The Journal of Trauma and Acute Care Surgery, vol. 74, no. 1, 2013, pp. 312-6.
Singer MB, Liou DZ, Clond MA, et al. Insurance-and race-related disparities decrease in elderly trauma patients. J Trauma Acute Care Surg. 2013;74(1):312-6.
Singer, M. B., Liou, D. Z., Clond, M. A., Bukur, M., Mirocha, J., Margulies, D. R., Salim, A., & Ley, E. J. (2013). Insurance-and race-related disparities decrease in elderly trauma patients. The Journal of Trauma and Acute Care Surgery, 74(1), 312-6. https://doi.org/10.1097/TA.0b013e31826fc899
Singer MB, et al. Insurance-and Race-related Disparities Decrease in Elderly Trauma Patients. J Trauma Acute Care Surg. 2013;74(1):312-6. PubMed PMID: 23147178.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Insurance-and race-related disparities decrease in elderly trauma patients. AU - Singer,Matthew B, AU - Liou,Douglas Z, AU - Clond,Morgan A, AU - Bukur,Marko, AU - Mirocha,James, AU - Margulies,Daniel R, AU - Salim,Ali, AU - Ley,Eric J, PY - 2012/11/14/entrez PY - 2012/11/14/pubmed PY - 2013/3/22/medline SP - 312 EP - 6 JF - The journal of trauma and acute care surgery JO - J Trauma Acute Care Surg VL - 74 IS - 1 N2 - BACKGROUND: Little focus is on health care disparities in the elderly, a population largely covered by public insurance. We characterized insurance type and race in elderly trauma patients to determine if lack of insurance or minority status predict increased mortality. METHODS: The National Trauma Data Bank (version 7.0) was queried for all adult blunt trauma patients. We divided patients into two cohorts (15-64 or ≥ 65 years) based on age for universal Medicare eligibility. Our primary outcome measure was in-hospital mortality. Multiple logistic regression was used to control for confounding variables. RESULTS: A total of 541,471 patients met inclusion criteria. Among younger patients, the most common insurance type was private (41.0%), with 26.9% uninsured. In contrast, the most common insurance type among older patients was Medicare (64.6%), with 6.0% uninsured. Within the younger cohort, private insurance (adjusted odds ratio [AOR], 0.6; p < 0.01) and other insurance (AOR, 0.8; p < 0.01) predicted reduced mortality, while Medicare predicted similar mortality (AOR, 1.1; p = 0.18) compared with no insurance. Black race (AOR, 1.4; p < 0.01) and Hispanic ethnicity (AOR, 1.4; p < 0.01) predicted higher mortality compared with white race. Within the older cohort, no insurance predicted similar mortality as Medicare (AOR, 1.0; p = 0.43), private insurance (AOR, 1.0; p = 0.51), and other insurance (AOR, 1.0; p = 0.71). Hispanic ethnicity predicted increased mortality (AOR, 1.4; p < 0.01), while Asian race was protective (AOR, 0.7; p = 0.01) compared with white race. CONCLUSION: Elderly trauma patients present primarily with Medicare, while younger trauma patients are mostly privately insured; elderly patients are four times more likely to be insured. Disparities caused by lack of insurance and minority race are reduced in elderly trauma patients. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III. SN - 2163-0763 UR - https://www.unboundmedicine.com/medline/citation/23147178/Insurance_and_race_related_disparities_decrease_in_elderly_trauma_patients_ L2 - https://doi.org/10.1097/TA.0b013e31826fc899 DB - PRIME DP - Unbound Medicine ER -