Associations of race, mechanism of injury, and neighborhood poverty with in-hospital mortality from trauma

Abstract

Health disparities based on race and socioeconomic status are a serious problem in the US health care system, but disparities in outcomes related to traumatic injury have received relatively little attention in the research literature.This study uses data from the State Inpatient Database for Michigan including all trauma-related hospital admissions in the period from 2006 to 2014 in the Detroit metropolitan area (N = 407,553) to examine the relationship between race (White N = 232,109; African American N = 86,356, Hispanic N = 2709, Other N = 10,623), socioeconomic background, and in-hospital trauma mortality.Compared with other groups, there was a higher risk of mortality after trauma among African Americans (odds ratio [OR] = 1.20, P < .001), people living in high-poverty neighborhoods (OR = 1.01, P < .001), and those enrolled in public health insurance programs (OR = 1.53, P < .001). African American patients were more likely to have had traumatic injuries caused by certain mechanisms with higher risk of death (P < .001). After controlling for mechanism alone in multiple logistic regression, African American race remained a significant predictor of mortality risk (OR = 1.12, P < .001). After additionally controlling for the socioeconomic factors of insurance status and neighborhood poverty levels, there were no longer any significant differences between racial groups in terms of mortality (OR = 0.99, P = .746).These results suggest that in this population the racial inequalities in mortality outcomes were fully mediated by differences between groups in the pattern of injuries suffered and differences in risk based on socioeconomic factors.

Factors associated with survival in adult patients with traumatic arrest: a retrospective cohort study from US trauma centers

“…Demographic factors positively associated with survival included age group (16–64) (compared to age ≥ 65) and female gender. This differs from previous studies [ 5 , 18 , 21 ] where no similar associations were reported. Patients in the younger age are usually expected to have better odds of survival because of lower comorbidities.…”

“…The available literature reports contradicting findings on financial coverage and association with survival in trauma patients. Greene et al concluded that insurance status was a predictor of outcome with uninsured patients being at higher risk of death in both blunt and penetrating trauma [ 34 ] while Lober et al [ 21 ] noted better survival in patients with no insurance coverage attributing this finding to potentially larger proportion of healthy patients in the uninsured group. In this study of traumatic arrests any insurance status (compared to uninsured) was associated with improved outcomes.…”

Factors associated with survival in Adult Patients with Traumatic Arrest: A Retrospective Cohort Study from US Trauma Centers

“…This differs from previous studies 5,16,19 where no similar associations were reported. Patients in the younger age are usually expected to have better odds of survival because of lower comorbidities.…”

“…The available literature reports contradicting ndings on nancial coverage and association with survival in trauma patients. Greene et al concluded that insurance status was a predictor of outcome with uninsured patients being at higher risk of death in both blunt and penetrating trauma 34 while Lober et al noted a better survival in patients with no insurance coverage 19 attributing this nding to potentially larger proportion of healthy patients in the uninsured group. In this study of traumatic arrests any insurance status (compared to uninsured) was associated with improved outcomes.…”

Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region

“…Health disparities in outcomes for race and sex have been identified throughout medicine. [1][2][3][4][5][6] Although life expectancy gaps have improved over time, between 2016 and 2017, black Americans had a life expectancy of about 3.5 years less than white Americans. 7 Additionally, in 2018, men had a life expectancy of approximately 5 years less than women in the United States.…”