Association of Insurance Status with Health Outcomes Following Traumatic Injury: Statewide Multicenter Analysis

Abstract

IntroductionRecognizing disparities in definitive care for traumatic injuries created by insurance status may help reduce the higher risk of trauma-related mortality in this population. Our objective was to understand the relationship between patients’ insurance status and trauma outcomes.MethodsWe collected data on all patients involved in traumatic injury from eight Level I and 15 Level IV trauma centers, and four non-designated hospitals through Arizona State Trauma Registry between January 1, 2008 and December 31, 2011. Of 109,497 records queried, we excluded 29,062 (26.5%) due to missing data on primary payer, sex, race, zip code of residence, injury severity score (ISS), and alcohol or drug use. Of the 80,435 cases analyzed, 13.3% were self-pay, 38.8% were Medicaid, 13% were Medicare, and 35% were private insurance. We evaluated the association between survival and insurance status (private insurance, Medicare, Medicaid, and self-pay) using multiple logistic regression analyses after adjusting for race/ethnicity (White, Black/African American, Hispanic, and American Indian/Alaska Native), age, gender, income, ISS and injury type (penetrating or blunt).ResultsThe self-pay group was more likely to suffer from penetrating trauma (18.2%) than the privately insured group (6.0%), p<0.0001. There were more non-White (53%) self-pay patients compared to the private insurance group (28.3%), p<0.0001. Additionally, the self-pay group had significantly higher mortality (4.3%) as compared to private insurance (1.9%), p<0.0001.A simple logistic regression revealed higher mortality for self-pay patients (crude OR= 2.32, 95% CI [2.07–2.67]) as well as Medicare patients (crude OR= 2.35, 95% CI [2.54–3.24]) as compared to private insurance. After adjusting for confounding, a multiple logistic regression revealed that mortality was highest for self-pay patients as compared to private insurance (adjusted OR= 2.76, 95% CI [2.30–3.32]).ConclusionThese results demonstrate that after controlling for confounding variables, self-pay patients had a significantly higher risk of mortality following a traumatic injury as compared to any other insurance-type groups. Further research is warranted to understand this finding and possibly decrease the mortality rate in this population.

“Making It Work”: A Preliminary Mixed Methods Study of Rural Trauma Care Access and Resources in New Mexico

“…They consistently pointed to health insurance, which many New Mexicans struggle to access [8,9], especially those in rural areas living far from care, as a related key factor determining trauma patient outcomes. This assertion is consistent with existing literature demonstrating that trauma outcomes are poorer for patients without health insurance at the time of their injury [24,25].…”

Socioeconomic disparities in the thoracic trauma population

“…1 Socioeconomic disparities in the trauma population have been well documented in the literature, and trauma patients without insurance have been shown repeatedly to have inferior outcomes and higher mortality. [2][3][4][5][6] Unfortunately, there has been a paucity of data in the literature regarding the impact of race and insurance status on trauma patients with severe thoracic trauma.…”

Insurance Does Not Affect Adverse Events While Awaiting Surgery for Ankle Trauma in One System

“…This is in contrast to previous studies in which acute trauma patients had increased rates of mortality and complications when they did not have insurance. [9][10][11] Furthermore, previous research showed that obtaining follow-up care can be difficult, 2,3 which seems paramount to patients who are often discharged with the intent to secure outpatient surgical services. Previous research also indicated follow-up was particularly difficult to obtain for those on Medicaid and without insurance.…”

“…Along with prolonged instability and potential permanent loss of or decrease in mobility, ankle fractures that do not heal in proper alignment are seven times more likely to develop ankle arthritis, which can cause pain and stiffness requiring long-term treatments. 8 Trauma patients without insurance have increased rates of mortality and complications, [9][10][11] indicating that there may be disparities in accessible care for trauma patients. Understanding barriers to proper care may provide information that could lead to achieving more health equality as dictated by Healthy People 2020 12 and other groups.…”