Insurance Coverage Is Associated with Mortality after Gunshot Trauma

Dozier, Kristopher C.; Miranda, Marvin A.; Kwan, Rita O.; Cureton, Elizabeth L.; Sadjadi, Javid; Victorino, Gregory P.

doi:10.1016/j.jamcollsurg.2009.12.002

Cited by 41 publications

(30 citation statements)

References 15 publications

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“…With respect to traumatic injury, studies using the National Trauma Data Bank (NTDB) have shown that uninsured Americans have a 1.3- to 3.3-fold higher risk of traumatic death, as compared to patients with commercial or private insurance. 1 , 17 – 25 These prior studies have been limited to intentional injuries, 24 , 26 , 27 to injuries with greater severity, 21 , 22 , 28 or to a subset of injury mechanisms such as motor vehicle crashes 29 or pedestrian deaths. 25 In addition, NTDB data represent predominately urban trauma centers; i.e.…”

Section: Introductionmentioning

confidence: 99%

Not Just an Urban Phenomenon: Uninsured Rural Trauma Patients at Increased Risk for Mortality

Ahmed¹,

Harland²,

Hoffman³

et al. 2015

WestJEM

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IntroductionNational studies of largely urban populations showed increased risk of traumatic death among uninsured patients, as compared to those insured. No similar studies have been done for major trauma centers serving rural states.MethodsWe performed retrospective analyses using trauma registry records from adult, non-burn patients admitted to a single American College of Surgeons-certified Level 1 trauma center in a rural state (2003–2010, n=13,680) and National Trauma Data Bank (NTDB) registry records (2002–2008, n=380,182). Risk of traumatic death was estimated using multivariable logistic regression analysis.ResultsWe found that 9% of trauma center patients and 27% of NTDB patients were uninsured. Overall mortality was similar for both (~4.5%). After controlling for covariates, uninsured trauma center patients were almost five times more likely to die and uninsured NTDB patients were 75% more likely to die than commercially insured patients. The risk of death among Medicaid patients was not significantly different from the commercially insured for either dataset.ConclusionOur results suggest that even with an inclusive statewide trauma system and an emergency department that does not triage by payer status, uninsured patients presenting to the trauma center were at increased risk of traumatic death relative to patients with commercial insurance.

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Section: Introductionmentioning

confidence: 99%

Not Just an Urban Phenomenon: Uninsured Rural Trauma Patients at Increased Risk for Mortality

Ahmed¹,

Harland²,

Hoffman³

et al. 2015

WestJEM

View full text Add to dashboard Cite

show abstract

“…42 Unintentional injury is also more common among the uninsured, 32,33 with nearly 75% of patients injured from gunshots presenting without insurance. 34 In our study, despite the overall gains in insurance after health care reform, uninsurance remained high among patients experiencing penetrating trauma. Thus, common factors may both increase the risk of certain types of injury and preclude compliance with an individual mandate.…”

Section: Discussionmentioning

confidence: 52%

Rates of Insurance for Injured Patients Before and After Health Care Reform in Massachusetts: A Possible Case of Double Jeopardy

et al. 2014

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“…This may reflect socioeconomic influences that are difficult to discern from a large database review. Despite numerous studies showing the differences in cancer 13–16 and trauma 17–20 care by socioeconomic and insurance status, there was no indication that insurance status impacted BDI rates. The increased risk of BDI in teaching institutions may be associated with the complexities of patients treated at these centers or the learning curve associated with resident training (or both).…”

Section: Discussionmentioning

confidence: 89%