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Minority Trauma Patients Tend to Cluster at Trauma Centers with Worse-Than-Expected Mortality: Can This Phenomenon Help Explain Racial Disparities in Trauma Outcomes?

Haider, Adil H. MD, MPH*,†; Hashmi, Zain G. MBBS*; Zafar, Syed Nabeel MBBS, MPH; Hui, Xuan MD, ScM*; Schneider, Eric B. PhD*; Efron, David T. MD*; Haut, Elliott R. MD*; Cooper, Lisa A. MD, MPH; MacKenzie, Ellen J. PhD; Cornwell, Edward E. III MD

Annals of Surgery:
doi: 10.1097/SLA.0b013e3182a50148
Papers of the 133rd ASA Annual Meeting
Abstract

Objectives: To determine whether minority trauma patients are more commonly treated at trauma centers (TCs) with worse observed-to-expected (O/E) survival.

Background: Racial disparities in survival after traumatic injury have been described. However, the mechanisms that lead to these inequities are not well understood.

Methods: Analysis of level I/II TCs included in the National Trauma Data Bank 2007–2010. White, Black, and Hispanic patients 16 years or older sustaining blunt/penetrating injuries with an Injury Severity Score of 9 or more were included. TCs with 50% or more Hispanic or Black patients were classified as predominantly minority TCs. Multivariate logistic regression adjusting for several patient/injury characteristics was used to predict the expected number of deaths for each TC. O/E mortality ratios were then generated and used to rank individual TCs as low (O/E <1), intermediate, or high mortality (O/E >1).

Results: A total of 556,720 patients from 181 TCs were analyzed; 86 TCs (48%) were classified as low mortality, 6 (3%) intermediate, and 89 (49%) as high mortality. More of the predominantly minority TCs [(82% (22/27) vs 44% (67/154)] were classified as high mortality (P < 0.001). Approximately 64% of Black patients (55,673/87,575) were treated at high-mortality TCs compared with 54% Hispanics (32,677/60,761) and 41% Whites (165,494/408,384) (P < 0.001).

Conclusions: Minority trauma patients are clustered at hospitals with significantly higher-than-expected mortality. Black and Hispanic patients treated at low-mortality hospitals have a significantly lower odds of death than similar patients treated at high-mortality hospitals. Differences in TC outcomes and quality of care may partially explain trauma outcomes disparities.

In Brief

Mechanisms leading to racial disparities in trauma outcomes remain ill characterized. We describe that minority trauma patients are clustered at hospitals with significantly higher-than-expected mortality. Differences in trauma center outcomes and quality of care may partially explain inequalities in survival after injury.

Author Information

*Center for Surgical Trials and Outcomes Research, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Department of Surgery, Howard University College of Medicine, Washington, DC.

Reprints: Adil H. Haider, MD, MPH, Center for Surgical Trials and Outcomes Research, Department of Surgery, The Johns Hopkins School of Medicine, Sheikh Zayed Tower, Ste 6107, 1800 Orleans St, Baltimore, MD 21287. E-mail: ahaider1@jhmi.edu.

Supported by National Institutes of Health grant (NIGMS K23GM093112-01; A.H. Haider); American College of Surgeons C. James Carrico Fellowship for the study of Trauma and Critical Care (A.H. Haider); and National Institute of Health/National Heart, Lung, and Blood Institute grants (K24HL083113 and P50HL0105187; L.A. Cooper).

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Disclosure: The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.