NEW ORLEANS — Minority and uninsured patients are significantly more likely to die after injury than are white, insured patients, Dr. Adil H. Haider reported at the annual clinical congress of the American College of Surgeons.
He concluded that black uninsured patients were 78% more likely to die after trauma, and that Hispanic patients without insurance were more than 130% more likely to die than white insured patients, even after controlling for numerous confounding factors.
Dr. Haider, a trauma surgeon at Johns Hopkins University, Baltimore, extracted his data from the 2001–2005 National Trauma Data Bank. He assessed mortality after moderate to severe trauma in 377,000 patients: 69% were white, 19% black, and 11% Hispanic. Patients included in the study were adults between the ages of 18 and 65 (mean age 36 years), and 70% were male.
Overall, 53% of patients had some kind of commercial medical insurance, and 47% were either self-pay or Medicaid recipients. Blacks were most likely to be uninsured (69%), followed by Hispanics (62%) and whites (38%).
Hispanics had the highest crude mortality, with 9% dying after their injury, compared with 8% of blacks and 5.5% of whites. Mortality was also significantly different between insured and uninsured patients (8% vs. 4% in the unadjusted analysis).
The adjusted mortality analysis controlled for injury severity using the Injury Severity Score, Revised Trauma Score, and Abbreviated Injury Scale. Dr Haider also controlled for age, gender, severe extremity injury, type of injury (blunt vs. penetrating), and mechanism of injury, based on ICD-9 codes.
The multivariate analysis showed that race and insurance were still significantly associated with the risk of death. Compared with whites, blacks were 17% more likely to die and Hispanics 47% more likely to die. Uninsured patients were 46% more likely to die than were insured patients.
To further stratify the effect of race and insurance, Dr. Haider broke down the groups according to both factors. Compared with insured white patients, insured black patients and uninsured Hispanic patients were still significantly more likely to die (20% and 51%, respectively).
Uninsured white and black patients were significantly more likely to die (55% and 78%, respectively), than were insured white patients. Uninsured Hispanic patients faced the highest risk—they were 2.3 times more likely than insured white patients to die from similar injuries.
Black uninsured patients were 78% more likely to die after trauma than white insured patients. DR. HAIDER