Annals of Surgery

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

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

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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.

© 2013 by Lippincott Williams & Wilkins.


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