Uninsured status may be more predictive of outcomes among the severely injured than minority race

Abstract

Aim Worse outcomes in trauma in the United States have been reported for both the uninsured and minority race. We sought to determine whether disparities would persist among severely injured patients treated at trauma centres where standard triage trauma protocols limit bias from health systems and providers. Methods We performed a retrospective analysis of the 2010 to 2012 National Sample Program from the National Trauma Databank, which is a nationally representative sample of trauma centre performance in the United States. The database was screened for adults ages 18 to 64 who had a known insurance status. Outcomes measured were in-hospital mortality and post-hospital care. Results There were 739,149 injured patients included in the analysis. Twenty-eight percent were uninsured, and 34 percent were of minority race. In the adjusted analysis, uninsured status (OR 1.60, 1.29 – 1.98, p<0.001) and black race (OR 1.24, 1.04 – 1.49, p=0.019) were significant predictors of mortality. Only uninsured status was a significant negative predictor of post-hospital care (OR 0.43, 0.36 – 0.51, p<0.001). As injury severity increased, only insurance status was a significant predictor of both increased mortality (OR 1.68, 1.29 – 2.19, p<0.001) and decreased post-hospital care (OR 0.45, 0.32 – 0.63, p<0.001). Conclusion Uninsured status is independently associated with higher in-hospital mortality and decreased post-hospital care in patients with severe injuries in a nationally representative sample of trauma centres in the United States. Increased in-hospital mortality is likely due to endogenous patient factors while decreased post-hospital care is likely due to economic constraints. Minority race is less of a factor influencing disparate outcomes among the severely injured.

Racial disparities in mortality after severe traumatic brain injury in childhood: mediators identified by Oaxaca-Blinder decomposition of trauma registry data

“…Like the effect of race, the effect of insurance status on trauma mortality must be mediated by other factors. The current analysis confirms past work indicating that economic status, as reflected in insurance coverage, has an association with trauma mortality independent of race and possibly more important than it (Haider et al 2008 ; Rosen et al 2009 ; Salim et al 2010 ; Gerry et al 2016 ). Trauma data sources that are granular with respect both to clinical and to economic covariates are needed to address this question more conclusively, but none are known to the author.…”

Race and Insurance Status as Predictors of Bicycle Trauma Outcome in Adults

“…In addition, of note, although some prior investigations have shown stronger relationships between race/ ethnicity with rates of mortality among adults, the results of this study are supported by several other studies that also determined that race/ethnicity may not be strong predictors of in-hospital mortality on controlling for insurance status and injury severity. [29][30][31][32][33][34][35] Analyzing helmet use and mortality rates among adult trauma patients is particularly important given the disproportionately high rates of bicycle injury and fatality in adults. It is important to examine these relationships with more granularity, that is, within varying racial/ethnic and socioeconomic subpopulations, as this elucidates how outcomes are driven by nonmedical factors.…”

Trends in COVID-19 Health Disparities in North Carolina: Preparing the Field for Long-Haul Patients

“…Disparities in treatment and outcomes for uninsured patients have been documented for multiple diseases and medical conditions, and they can be even more significant than disparities due to race alone. These disparities may stem from multiple factors such as challenges to access appropriate care, decreased health outcomes, and differences in the quality of care [ 34 ]. A report by Families USA uncovered that health insurance gaps were linked to more than 40% of infections and one out of three COVID-19 deaths.…”