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Trauma care does not discriminate: The association of race and health insurance with mortality following traumatic injury

Osler, Turner MD, MSc; Glance, Laurent G. MD; Li, Wenjun PhD; Buzas, Jeffery S. PhD; Wetzel, Megan L. MSc; Hosmer, David W. PhD

Journal of Trauma and Acute Care Surgery: May 2015 - Volume 78 - Issue 5 - p 1026–1033
doi: 10.1097/TA.0000000000000593
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BACKGROUND Previous studies have reported that black race and lack of health insurance coverage are associated with increased mortality following traumatic injury. However, the association of race and insurance status with trauma outcomes has not been examined using contemporary, national, population-based data.

METHODS We used data from the National Inpatient Sample on 215,615 patients admitted to 1 of 836 hospitals following traumatic injury in 2010. We examined the effects of race and insurance coverage on mortality using two logistic regression models, one for patients younger than 65 years and the other for older patients.

RESULTS Unadjusted mortality was low for white (2.71%), black (2.54%), and Hispanic (2.03%) patients. We found no difference in adjusted survival for nonelderly black patients compared with white patients (adjusted odds ratio [AOR], 1.04; 95% confidence interval [CI], 0.90–1.19; p = 0.550). Elderly black patients had a 25% lower odds of mortality compared with elderly white patients (AOR, 0.75; 95% CI, 0.63–0.90; p = 0.002). After accounting for survivor bias, insurance coverage was not associated with improved survival in younger patients (AOR, 0.91; 95% CI, 0.77–1.07; p = 0.233).

CONCLUSION Black race is not associated with higher mortality following injury. Health insurance coverage is associated with lower mortality, but this may be the result of hospitals’ inability to quickly obtain insurance coverage for uninsured patients who die early in their hospital stay. Increasing insurance coverage may not improve survival for patients hospitalized following injury.

LEVEL OF EVIDENCE Epidemiologic and prognostic study, level III.

Supplemental digital content is available in the text.

From the Department of Surgery (T.O.), Department of Mathematics and Statistics (J.S.B.), and College of Medicine (M.L.W.), University of Vermont, Colchester, Vermont; Department of Anesthesiology (L.G.G.), University of Rochester, Rochester, New York; Schools of Medicine (W.L.), and Public Health and Health Sciences (D.W.H.), University of Massachusetts, Worcester, Massachusetts.

Submitted: September 26, 2014, Revised: December 20, 2014, Accepted: December 22, 2015.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

Address for reprints: Turner Osler, MD, MSc, Department of Surgery, University of Vermont, 789 Orchard Shore Rd, Colchester, VT 05446; email: tosler@uvm.edu.

© 2015 Lippincott Williams & Wilkins, Inc.