Abstract
IntroductionRecognizing disparities in definitive care for traumatic injuries created by insurance status may help reduce the higher risk of trauma-related mortality in this population. Our objective was to understand the relationship between patients’ insurance status and trauma outcomes.MethodsWe collected data on all patients involved in traumatic injury from eight Level I and 15 Level IV trauma centers, and four non-designated hospitals through Arizona State Trauma Registry between January 1, 2008 and December 31, 2011. Of 109,497 records queried, we excluded 29,062 (26.5%) due to missing data on primary payer, sex, race, zip code of residence, injury severity score (ISS), and alcohol or drug use. Of the 80,435 cases analyzed, 13.3% were self-pay, 38.8% were Medicaid, 13% were Medicare, and 35% were private insurance. We evaluated the association between survival and insurance status (private insurance, Medicare, Medicaid, and self-pay) using multiple logistic regression analyses after adjusting for race/ethnicity (White, Black/African American, Hispanic, and American Indian/Alaska Native), age, gender, income, ISS and injury type (penetrating or blunt).ResultsThe self-pay group was more likely to suffer from penetrating trauma (18.2%) than the privately insured group (6.0%), p<0.0001. There were more non-White (53%) self-pay patients compared to the private insurance group (28.3%), p<0.0001. Additionally, the self-pay group had significantly higher mortality (4.3%) as compared to private insurance (1.9%), p<0.0001.A simple logistic regression revealed higher mortality for self-pay patients (crude OR= 2.32, 95% CI [2.07–2.67]) as well as Medicare patients (crude OR= 2.35, 95% CI [2.54–3.24]) as compared to private insurance. After adjusting for confounding, a multiple logistic regression revealed that mortality was highest for self-pay patients as compared to private insurance (adjusted OR= 2.76, 95% CI [2.30–3.32]).ConclusionThese results demonstrate that after controlling for confounding variables, self-pay patients had a significantly higher risk of mortality following a traumatic injury as compared to any other insurance-type groups. Further research is warranted to understand this finding and possibly decrease the mortality rate in this population.
Highlights
Recognizing disparities in definitive care for traumatic injuries created by insurance status may help reduce the higher risk of trauma-related mortality in this population
After adjusting for confounding, a multiple logistic regression revealed that mortality was highest for self-pay patients as compared to private insurance
These results demonstrate that after controlling for confounding variables, self-pay patients had a significantly higher risk of mortality following a traumatic injury as compared to any other insurance-type groups
Summary
Recognizing disparities in definitive care for traumatic injuries created by insurance status may help reduce the higher risk of trauma-related mortality in this population. Multiple studies have shown insurance to be associated with health outcomes, including chronic diseases and medical complications.. Multiple studies have shown insurance to be associated with health outcomes, including chronic diseases and medical complications.1,2 This has been extended to include outcomes of different traumatic injury subsets.. Some evidence has shown similar associations between insurance status and mortality rates following traumatic injury among the pediatric population.. Salim et al. found insured trauma patients tend to be older, female, more likely to have blunt traumatic injuries, and tend to have a higher injury severity when compared to uninsured patients While the general presupposition is that uninsured patients tend to be given the same level of intensive care services as insured patients, uninsured patients have exhibited higher odds of in-hospital mortality after both blunt and penetrating injuries as compared to insured patients with the same type of injury. Some evidence has shown similar associations between insurance status and mortality rates following traumatic injury among the pediatric population. Salim et al. found insured trauma patients tend to be older, female, more likely to have blunt traumatic injuries, and tend to have a higher injury severity when compared to uninsured patients
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