Effect of Race and Insurance on Outcome of Pediatric Trauma

Authors

  • Wael Hakmeh DO,

    1. From the St. John Hospital and Medical Center (WH, JB, SMS, JMF, CBI), Detroit, MI; and the Wayne State University School of Medicine (JMF, CBI), Detroit, MI.
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  • Jarrod Barker MD,

    1. From the St. John Hospital and Medical Center (WH, JB, SMS, JMF, CBI), Detroit, MI; and the Wayne State University School of Medicine (JMF, CBI), Detroit, MI.
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  • Susan M. Szpunar PhD,

    1. From the St. John Hospital and Medical Center (WH, JB, SMS, JMF, CBI), Detroit, MI; and the Wayne State University School of Medicine (JMF, CBI), Detroit, MI.
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  • James M. Fox MD,

    1. From the St. John Hospital and Medical Center (WH, JB, SMS, JMF, CBI), Detroit, MI; and the Wayne State University School of Medicine (JMF, CBI), Detroit, MI.
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  • Charlene B. Irvin MD

    1. From the St. John Hospital and Medical Center (WH, JB, SMS, JMF, CBI), Detroit, MI; and the Wayne State University School of Medicine (JMF, CBI), Detroit, MI.
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  • Insurance disparity data presented at the American College of Emergency Physicians Research Forum, Boston, MA, October 2009; race and insurance disparity data presented at the Society for Academic Emergency Medicine Midwest Regional Meeting, Ann Arbor, MI, September 2009.

  • Supervising Editor: Lowell W. Gerson, PhD.

Address for correspondence and reprints: Wael Hakmeh, DO; e-mail: whakmeh@yahoo.com.

Abstract

ACADEMIC EMERGENCY MEDICINE 2010; 17:809–812 © 2010 by the Society for Academic Emergency Medicine

Abstract

Objectives:  This study sought to determine if insurance or race status affect trauma outcomes in pediatric trauma patients.

Methods:  Using the National Trauma Data Bank (NTDB; v6.2), the following variables were extracted: age (0–17 years), payment type (insured, Medicaid/Medicare, or self-pay), race (white, Black/African American, or Hispanic), Injury Severity Score (ISS > 8), type of trauma (blunt or penetrating), and discharge status (alive or dead). Data were analyzed using logistic regression.

Results:  Of the 70,781 patient visits analyzed, 67% were insured, 23% were Medicaid/Medicare, and 10% were self-pay. Self-pay patients had higher mortality (11%, compared to Medicaid/Medicare at 5% and insured at 4%; p < 0.001). African Americans and Hispanics also had higher mortality (7 and 6%) compared to whites (4%; p < 0.001). Self-pay patients more likely suffered penetrating trauma than insured patients (12% vs. 4%; p < 0.001), and mortality for penetrating trauma self-pay patients was 29%, compared to only 11% for penetrating trauma insured patients (p < 0.001). The mortality rate varied from a low of 3% for insured whites, to 18% for self-pay African Americans. Logistic regression (including race, insurance status, injury type, and ISS) revealed that African Americans and Hispanics both had an increased risk of death compared to whites (African American odds ratio [OR] = 1.37, Hispanic OR = 1.20). Medicaid/Medicare patients had a slightly increased risk of death with OR = 1.14, but self-pay patients were almost three times more likely to die (adjusted OR = 2.92).

Conclusions:  After controlling for ISS and type of injury, mortality disparity exists for uninsured, African American, and Hispanic pediatric trauma patients. Although the reasons for this are unclear, efforts to decrease these disparities are needed.

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