Racial Disparities in Survival Among Injured Drivers

Haskins, Amy; Clark, David E.; Travis, Lori L.

doi:10.1093/aje/kws242

Cited by 16 publications

(8 citation statements)

References 24 publications

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“…Recent meta-analyses of research investigating racial disparities in both trauma care and surgical outcomes further support the finding that Black patients tend to have higher adjusted mortality rates compared to similar White patients 9, 10 . Similar health care inequities have been reported in the pediatric (aged 0–17 years) trauma population 1 , and in populations with a wide range of injury mechanisms 2–7 .…”

Section: Introductionsupporting

confidence: 70%

Association Between Race and Age in Survival After Trauma

et al. 2014

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Importance Racial disparities in survival after trauma are well-described for patients less than 65 years of age. Similar information among older patients is lacking as existing trauma databases do not include important patient co-morbidity information. Objective To determine whether disparities in trauma survival for Blacks versus Whites persist in patients aged ≥65 years using an approach that adjusts for both patient injury severity and co-morbidity information in data analysis. Setting Nationwide Inpatient Sample (NIS, 2003–2010) Participants Trauma patients were extracted from the NIS using ICD-9-CM diagnosis codes. Injury severity was ascertained by applying the Trauma Mortality Prediction Model, and patient co-morbidities were quantified using the Charlson Co-Morbidity Index (CCI). Main Outcomes and Measures The odds of death after trauma for Blacks versus Whites for younger (age 16–64 years) and older (age ≥65 years) patients were compared using 3 different statistical methods: multivariable logistic regression with and without clustering for hospital effects and coarsened exact matching. Model covariates included age, gender, insurance status, mechanism of injury, overall injury severity, head injury severity, and co-morbid conditions. Results 1,073,195 patients were included (502,167 patients aged 16–64 years; 571,028 patients aged ≥65 years). The majority of older patients were White (95.9%), female (71.1%), insured (99.4%), with CCI scores ≥ 1 (56.7%). The unadjusted odds of death for Blacks versus Whites was 1.35 (95% CI 1.28–1.42) for patients aged 16–64 years, and 1.00 (95% CI 0.93–1.08) for patients aged ≥65 years. After risk-adjustment, racial disparities in survival persisted in the younger Black age group [1.21 (95% CI 1.13–1.30)] but were reversed in the older age group [0.83 (95% CI 0.76–0.90)]. This finding was consistent across all three statistical methods. Conclusions and Relevance In this study that risk-adjusts for both patient-specific co-morbidity data and injury severity information, differential racial disparities exist between White patients and Black patients depending on their age group. While younger White patients have better outcomes after trauma than younger Black patients, older White patients have a higher odds of death than older Black patients. Exploration of this paradoxical finding may help us better understand mechanisms that lead to disparities in trauma outcomes.

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Section: Introductionsupporting

confidence: 70%

Association Between Race and Age in Survival After Trauma

et al. 2014

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“…Racial disparities in mortality from other types of trauma have previously been documented with Blacks having higher odds of both in-hospital and post-discharge mortality 5, 6 . Using data from the Healthcare Cost and Utilization project, it was determined that Blacks had a higher odds of in-hospital mortality after mild to moderate injuries due to any mechanism than whites (OR 1.40, 95% CI 1.18–1.66) 7 .…”

Section: Introductionmentioning

confidence: 96%

Outcomes of trauma admission for falls: influence of race and age on inhospital and post-discharge mortality

Strong

Torain

Greene

et al. 2016

The American Journal of Surgery

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Background Racial disparities in trauma outcomes occur but disparities in fall mortality are unknown. Objectives To determine in-hospital and one-year fall mortality among patients discharged from an urban trauma center. Methods We conducted a retrospective analysis of fall patients in our trauma registry (1997–2008) linked to the National Death Index to determine post-discharge mortality. Statistical analysis included chi-squared tests, multivariable logistic regression and Cox proportional hazards models. Results There were 7,541 fall admissions. There was no clinically significant difference in in-hospital mortality between blacks and whites with age stratification. One year post-discharge, Blacks younger than 65 were more likely to die of disease (HR 1.37; 95% CI 1.14–1.62). Conclusion While rates of in-hospital mortality are similar, Blacks under the age of 65 have a higher risk of dying following discharge due to disease when stratified by age highlighting the need for continued medical follow up and prevention efforts.

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“…TBI without fatality was coded to compare with ED visit and hospitalization health data consistent with Haskins et al (2013).AIS 2+w/ F: represents the number of occupants with an AIS 2+ head injury and a fatality.AIS 3+H: represents the number of occupants with an AIS 3+ head injury with hospitalization (HOSPSTAY: 1–61).AIS 3+H w/o F: represents the number of occupants with an AIS 3+ head injury with hospitalization and no fatality.AIS 3+ w/ F: represents the number of occupants with an AIS 3+ head injury and a fatality.F w/ head as cause of death: represents the number of fatal occupants with TBI listed as a cause of death (CAUSE: 1–3).…”

Section: Methodsmentioning

confidence: 99%

“…TBI without fatality was coded to compare with ED visit and hospitalization health data consistent with Haskins et al (2013).…”

Section: Methodsmentioning

confidence: 99%

Head injuries (TBI) to adults and children in motor vehicle crashes

Viano¹,

Parenteau²,

et al. 2017

Traffic Injury Prevention

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Purpose This is a descriptive study. It determined the annual, national incidence of head injuries (traumatic brain injury, TBI) to adults and children in motor vehicle crashes. It evaluated NASS-CDS for exposure and incidence of various head injuries in towaway crashes. It evaluated 3 health databases for emergency department (ED) visits, hospitalizations, and deaths due to TBI in motor vehicle occupants. Methods Four databases were evaluated using 1997–2010 data on adult (15+ years old) and child (0– 14 years old) occupants in motor vehicle crashes: (1) NASS-CDS estimated the annual incidence of various head injuries and outcomes in towaway crashes, (2) National Hospital Ambulatory Medical Care Survey (NHAMCS)-estimated ED visits for TBI, (3) National Hospital Discharge Survey (NHDS) estimated hospitalizations for TBI, and (4) National Vital Statistics System (NVSS) estimated TBI deaths. The 4 databases provide annual national totals for TBI related injury and death in motor vehicle crashes based on differing definitions with TBI coded by the Abbreviated Injury Scale (AIS) in NASS-CDS and by International Classification of Diseases (ICD) in the health data. Results Adults: NASS-CDS had 16,980 ± 2,411 (risk = 0.43 ± 0.06%) with severe head injury (AIS 4+) out of 3,930,543 exposed adults in towaway crashes annually. There were 49,881 ± 9,729 (risk = 1.27 ± 0.25%) hospitalized with AIS 2+ head injury, without death. There were 6,753 ± 882 (risk = 0.17 ± 0.02%) fatalities with a head injury cause. The public health data had 89,331±6,870 ED visits, 33,598±1,052 hospitalizations, and 6,682±22 deaths with TBI. NASS-CDS estimated 48% more hospitalized with AIS 2+ head injury without death than NHDS occupants hospitalized with TBI. NASS-CDS estimated 29% more deaths with AIS 3+ head injury than NVSS occupant TBI deaths but only 1% more deaths with a head injury cause. Children: NASS-CDS had 1,453 ± 318 (risk = 0.32 ± 0.07%) with severe head injury (AIS 4+) out of 454,973 exposed children annually. There were 2,581 ± 683 (risk = 0.57 ± 0.15%) hospitalized with AIS 2+ head injury, without death. There were 466 ± 132 (risk = 0.10 ± 0.03%) fatalities with a head injury cause. The public health data had 19,251 ± 2,803 ED visits, 3,363 ± 255 hospitalizations, and 488 ± 6 deaths with TBI. NASS-CDS estimated 24% fewer hospitalized children with AIS 2+ head injury without death than NHDS hospitalization with TBI. NASS-CDS estimated 31% more deaths with AIS 3+ head injury than NVSS child deaths but 5% fewer deaths with a head injury cause. Conclusions The annual national incidence of motor vehicle–related head injury (TBI) was estimated using 1997–2010 NASS-CDS from the Department of Transportation and NHAMCS (ED visits), NHDS (hospitalizations), and NVSS (deaths) from the Department of Health and Human Services. The transportation and health databases use different definitions and coding, which complicates direct comparisons. Future work is needed where ICD to AIS translators are used if comparisons of serious head injur...

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Racial Disparities in Survival Among Injured Drivers

Cited by 16 publications

References 24 publications

Association Between Race and Age in Survival After Trauma

Association Between Race and Age in Survival After Trauma

Outcomes of trauma admission for falls: influence of race and age on inhospital and post-discharge mortality

Head injuries (TBI) to adults and children in motor vehicle crashes

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