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Racial Disparities in Mortality Among Adults Hospitalized After Injury

Arthur, Melanie PhD*; Hedges, Jerris R. MD, MS; Newgard, Craig D. MD, MPH; Diggs, Brian S. PhD; Mullins, Richard J. MD

doi: 10.1097/MLR.0b013e31815b9d8e
Original Article

Background: Injury is a major cause of death in adults. Although racial disparities in healthcare access and health outcomes are well documented for medical conditions, the influence of race on access to emergent care after injury has received little scrutiny.

Objectives: We sought to determine whether race was associated with risk of in-hospital death after injury.

Research Design: Data from the Healthcare Cost and Utilization Project (1998–2002) were used to estimate multivariate models of in-hospital mortality, controlling for age, race, gender, comorbid conditions, injury severity, primary payer, median income of zip code of residence, and hospital type. Additional multivariate models were estimated among stratified subsets of patients, including injury severity and hospital type.

Subjects: Patients age 18–64 with a primary diagnosis of injury.

Results: Relative to injured white patients, black and Asian patients had a higher risk of death [1.5% vs. 2.1% and 2.0%, multivariate odds ratios (OR) = 1.14 and 1.39]. Other racial/ethnic groups showed no significant mortality difference from white patients. In stratified analyses, we found large black-white mortality disparities among mild to moderately injured patients (OR = 1.40, 95% confidence interval: 1.18–1.66), whereas Asian-white disparities were concentrated among more severely injured patients (OR = 1.37, 95% confidence interval: 1.03–1.80).

Conclusions: Black and Asian patients have a higher risk of death after injury than white patients. These data raise important questions about access to quality trauma care for racial minority patients.

From the *Department of Sociology, Portland State University, †Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, and ‡Trauma/Critical Care Section, Department of Surgery, Oregon Health & Science University, Portland, Oregon.

Supported by grant R49/CCR-006283 from the US Public Health Service, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, GA.

Reprints: Melanie Arthur, PhD, Department of Sociology, University of Alaska Fairbanks, 702D Gruening, P.O. Box 756480, Fairbanks, AK 99775-6480. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.