保险状况而非种族是车辆伤害结果的决定因素。

Insurance status, not race, is a determinant of outcomes from vehicular injury.

机构信息

Department of Surgery, University of Florida Health Science Center, University of South Florida, Jacksonville, FL 32209, USA.

出版信息

J Am Coll Surg. 2011 Apr;212(4):722-7; discussion 727-9. doi: 10.1016/j.jamcollsurg.2010.12.016.

DOI:10.1016/j.jamcollsurg.2010.12.016

PMID:21463821

Abstract

BACKGROUND

Hypothesizing that outcomes from specific injury mechanisms should not vary by race or socioeconomic status, we analyzed the relationship of race and ethnicity to fatality in motor vehicle crash victims treated during 2008 and 2009.

STUDY DESIGN

Logistic regression analysis of pooled administrative data assessed the contribution of patient demographics and injury severity to outcome, defined as mortality during acute hospitalization. Demographic factors included age, sex, race, ethnicity, and insurance. Severe injury was defined using ICD-9 Injury Severity Score (survival probability) p < 0.85, presence of up to 3 comorbidities, and/or diagnosis of spinal cord injury and/or traumatic brain injury. Mortality was stratified by survival time after trauma center arrival to death within 24 hours or thereafter. Factors contributing to outcomes were tested using chi square analysis of the calculated model estimate.

RESULTS

For 8,758 motor vehicle crash victims treated in state-designated trauma centers, age, sex, injury severity, and 2 or more comorbidities consistently predicted survival. Neither race nor ethnicity was associated with increased mortality risk. Being uninsured was related to death within 24 hours (p < 0.001). The majority of the uninsured who died within 24 hours had an ICD-9 Injury Severity Score p ≤ 0.5. Mortality risk after 24 hours was driven by traumatic brain injury and comorbidities.

CONCLUSIONS

The results of this study indicated that higher immediate mortality of the uninsured is a behavioral and socioeconomic rather than physiologic marker. This higher mortality is driven by increased injury severity that increases cost of care in uninsured survivors. This disparity suggests that risk-taking behavior, especially relating to safety practices and licensing regulations, is an important etiologic factor. Improved outcomes require better public education and enforcement in conjunction with improvements in processes of care.

摘要

背景

我们假设特定损伤机制的结果不应因种族或社会经济地位而异，因此分析了种族和族裔与 2008 年和 2009 年期间接受治疗的机动车事故受害者死亡的关系。

研究设计

使用汇总的行政数据进行逻辑回归分析，评估了患者人口统计学和伤害严重程度对结果（急性住院期间的死亡率）的贡献。人口统计学因素包括年龄、性别、种族、族裔和保险。严重损伤定义为 ICD-9 损伤严重程度评分（存活概率）p < 0.85，存在多达 3 种合并症，和/或诊断为脊髓损伤和/或创伤性脑损伤。根据创伤中心到达后到 24 小时内死亡或之后的生存时间对死亡率进行分层。使用计算模型估计的卡方分析测试导致结果的因素。

结果

对于在州指定创伤中心接受治疗的 8758 名机动车事故受害者，年龄、性别、损伤严重程度和 2 种或更多种合并症始终预测存活。种族和族裔均与增加的死亡风险无关。没有保险与 24 小时内死亡相关（p < 0.001）。在 24 小时内死亡的大多数没有保险的人都有 ICD-9 损伤严重程度评分 p ≤ 0.5。24 小时后死亡率由创伤性脑损伤和合并症驱动。