Trends in Racial Disparities for Injured Patients Admitted to Trauma Centers

Abstract

Objective. To determine whether outcome disparities between black and white trauma patients have decreased over the last 10 years. Data Source. Pennsylvania Trauma Outcome Study. Study Design. We performed an observational cohort study on 191,887 patients admitted to 28 Level 1 and Level II trauma centers. The main outcomes of interest were (1) death, (2) death or major complication, and (3) failure-to-rescue. Hospitals were categorized according to the proportion of black patients. Multivariate regression models were used to estimate trends in racial disparities and to assess whether the source of racial disparities was within or between hospitals. Principal Findings. Trauma patients admitted to hospitals with high concentrations of blacks (>20 percent) had a 45 percent higher odds of death (adj OR: 1.45, 95 percent CI: 1.09-1.92) and a 73 percent higher odds of death or major complication (adj OR: 1.73, 95 percent CI: 1.42-2.11) compared with patients admitted to hospitals treating low proportions of blacks. Blacks and whites admitted to the same hospitals had no difference in mortality (adj OR: 1.05, 95 percent CI: 0.87, 1.27) or death or major complications (adj OR: 1.01; 95 percent CI: 0.90, 1.13). The odds of overall mortality, and death or major complications have been reduced by 32 percent (adj OR: 0.68; 95 percent CI: 0.54-0.86) and 28 percent (adj OR: 0.72; 95 percent CI: 0.60-0.85) between 2000 and 2009, respectively. Racial disparities did not change over 10 years. Conclusion. Despite the overall improvement in outcomes, the gap in quality of care between black and white trauma patients in Pennsylvania has not narrowed over the last 10 years. Racial disparities in trauma are due to the fact that black patients are more likely to be treated in lower quality hospitals compared with whites. Key Words. Race, disparities, trauma Ethnic and racial disparities in health care quality are widespread and have been extensively documented. The age-adjusted mortality rate for black men is 19 percent higher than for white men (Gornick et al. 1996). Blacks are less likely to receive recommended care for acute myocardial infarctions (Cohen et al. 2010); pneumonia (Hausmann et al. 2009); hip fractures (Neuman et al.

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

“…The lack of a large observed difference in in-hospital mortality based on race differs from several previous studies 5–7 . Our study, however, focused on a single trauma center population removing the possibility of geographic location and possible inter-center variability in outcomes such as may occur in under resourced trauma centers serving large minority populations 23, 24 .…”

Racial and Ethnic Disparities in the Quality of Health Care

“…Nonetheless, blacks obtain care from hospitals with slightly lower-quality scores and higher mortality rates (65). Black low-birthweight infants and black trauma patients in Pennsylvania are seen in hospitals with higher risk-adjusted mortality rates (54,74). Blacks who are discharged from minority-serving hospitals often have higher rates of readmission (142).…”

Age and preexisting conditions as risk factors for severe adverse events and failure to rescue after injury

“…volume (10), proportion of minority patients (11)) that are associated with differential rates of FTR. Translating observational knowledge of FTR into improvements in center-level FTR rates is contingent upon developing hypotheses surrounding specific interventions and then testing them in a trauma populations at high risk for FTR.…”