Racial Differences in Treatment Approaches and Mortality Following Arterial Trauma

Moreira, Carla; Farber, Alik; Rybin, Denis; Doros, Gheorghe; Kalish, Jeffrey; Eberhardt, Robert T.; Siracuse, Jeffrey J.; Hamburg, Naomi M.

doi:10.1177/1538574415607360

Cited by 8 publications

(4 citation statements)

References 37 publications

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“…Investigations of racial disparities in trauma surgical management show that patients from underrepresented racial and ethnic groups frequently face increased odds of mortality after injury. [2][3][4] This mirrors findings across nontrauma surgical specialties that have consistently demon-strated that Black patients are more likely to die after surgery than White patients, after adjusting for other clinical, social, and demographic confounders. 5,6 Hospital characteristics, including populations served and the quality of care provided, are increasingly being investigated for their contributions to racial disparities in hospital-based care.…”

supporting

confidence: 64%

“…However, outcomes after trauma are not evenly distributed, particularly across racial groups. Investigations of racial disparities in trauma surgical management show that patients from underrepresented racial and ethnic groups frequently face increased odds of mortality after injury 2–4 . This mirrors findings across nontrauma surgical specialties that have consistently demonstrated that Black patients are more likely to die after surgery than White patients, after adjusting for other clinical, social, and demographic confounders 5,6 …”

mentioning

confidence: 74%

“…A variety of studies have examined the relationship between race and trauma mortality, with inconsistent findings 2,3,18–20 . A meta-analysis by Haider et al 4 pooled data from seven studies and found that Black patients had worse trauma mortality rates than White patients.…”

Section: Discussionmentioning

confidence: 99%

“…Avariety of studies have examined the relationship between race and trauma mortality, with inconsistent findings. 2,3,[18][19][20] A meta-analysis by Haider et al 4 pooled data from seven studies and found that Black patients had worse trauma mortality rates than White patients. A more recent study, however, performed a population-based adjusted analysis using NIS data and concluded that Black race was not associated with higher mortality.…”

Section: Discussionmentioning

confidence: 99%

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Race and trauma mortality: The effect of hospital-level Black–White patient race distribution

Kishawi

Tseng

Adomshick

et al. 2022

J Trauma Acute Care Surg

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BACKGROUNDRace-related health disparities have been well documented in the United States. In some settings, Black patients have better outcomes in hospitals that serve high proportions of Black patients. We hypothesized that Black trauma patients would have lower mortality in high Black-serving (H-BS) hospitals.METHODSWe identified all adult patients with Black or White race and with an Injury Severity Score of ≥4 from the 2017 National Inpatient Sample. We collected hospital identifier, mechanism, age, sex, comorbidities, urban-rural location, insurance, zip code income quartile, and injury severity calculated from International Classification of Diseases, Tenth Revision, codes. We used a previously published method to group hospitals by proportion of Black patients served: HB-S (top 5%), medium Black serving (5–25%), and low Black serving (L-BS; bottom 75%). Adjusted logistic regression using an interaction variable between race and hospital service rank (reference: White patients in H-BS) was used to identify factors associated with mortality.RESULTSWe analyzed 184,080 trauma patients (median age, 72 years [interquartile range, 55–84 years]; Injury Severity Score, 9 [4–10]), of whom 11.7% were Black. Overall mortality was 4%. Of 2,376 hospitals, 126 (5.3%) were H-BS and 469 (19.7%) were medium Black serving. Furthermore, 29.8% of Black and 3.6% of White patients were treated at H-BS hospitals, while 71.7% of White and 23.6% of Black patients were treated at L-BS hospitals (p < 0.001). Black patients had the lowest mortality at H-BS hospitals (odds ratio [OR], 0.76 [0.64–0.92]) and the highest mortality (OR, 1.43 [1.13–1.80]) at L-BS hospitals. White patients had the lowest mortality at L-BS hospitals (OR, 0.76 [0.64–0.92]).CONCLUSIONAfter adjusting for patient and hospital factors, disparities exist such that Black and White patients have the best outcomes in hospitals that treat those patients most frequently, suggesting potential for racial bias at the institutional level. Further efforts must be made to promote equitable treatment at all hospitals and reduce these disparities.LEVEL OF EVIDENCEPrognostic and Epidemiologic; Level IV.

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confidence: 64%

mentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Race and trauma mortality: The effect of hospital-level Black–White patient race distribution

Kishawi

Tseng

Adomshick

et al. 2022

J Trauma Acute Care Surg

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Disparities in Adult and Pediatric Trauma Outcomes: a Systematic Review and Meta‐Analysis

et al. 2020

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Background Although safeguards requiring emergency care are provided regardless of a patient's payor status, disparate outcomes have been reported in trauma populations. The purpose of this systematic review and meta‐analysis was to determine whether race/ethnicity or insurance status had an effect on mortality and to systematically present the literature in the adult and pediatric trauma populations during the last decade. Methods An online search of PubMed, Cochrane Library, Google Scholar, and SAGE Journals was performed for publications from January 2009 to March 2019. The Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines were used. The GRADE Working Group criteria were utilized to assess the evidence quality. A meta‐analysis was conducted to compare mortality between insured/uninsured and Caucasian/non‐Caucasian patients. Results Our search revealed 680 publications that qualified for evaluation. Of these, 41 were included in the final analysis. Twenty‐six studies included adults only, nine studies included pediatric patients only, and six studies evaluated both. Twelve studies evaluated the effects of race/ethnicity, 18 examined insurance status, and 11 investigated both. Uninsured patients had 22% greater odds of death than insured patients (OR 1.22; CI 1.21–1.24). Non‐Caucasian patients had 18% greater risk of death than Caucasian patients (OR 1.18; CI 1.17–1.20). Conclusion Both the adult and pediatric trauma populations suffer outcome disparities based on race/ethnicity and insurance status. Overall, patients without insurance coverage and minority groups (i.e., non‐Caucasians) had worse outcomes, as measured by odds of death and all‐cause mortality.

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Race and cultural issues

Marcaccio

Schermerhorn

2021

Vascular Disease in Women

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Racial Differences in Treatment Approaches and Mortality Following Arterial Trauma

Abstract: Even after adjusting for potential confounders, minority patients had increased odds of mortality following arterial trauma compared to their white counterparts. Further studies are needed to understand and to eliminate these observed disparities in outcome.

Cited by 8 publications

References 37 publications

Race and trauma mortality: The effect of hospital-level Black–White patient race distribution

Race and trauma mortality: The effect of hospital-level Black–White patient race distribution

Disparities in Adult and Pediatric Trauma Outcomes: a Systematic Review and Meta‐Analysis

Race and cultural issues

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