差异的严重程度：创伤后损伤强度增加会加剧不同的结果。
The severity of disparity: increasing injury intensity accentuates disparate outcomes following trauma.
作者信息
Losonczy Lia I, Weygandt P Logan, Villegas Cassandra V, Hall Erin C, Schneider Eric B, Cooper Lisa A, Cornwell Edward E, Haut Elliott R, Efron David T, Haider Adil H
出版信息
J Health Care Poor Underserved. 2014 Feb;25(1):308-20. doi: 10.1353/hpu.2014.0021.
OBJECTIVE
Studies have shown disparities in mortality among racial groups and among those with differing insurance coverage. Our goal was to determine if injury severity affects these disparities.
METHODS
We classified patients from the 2003-2008 National Trauma Data Banks suffering moderate to severe injuries into six groups based on race/ethnicity and insurance, stratifying by injury severity. Logistic regression compared odds of death between races-ethnicities/insurance groups within these strata. We adjusted for age, gender, Injury Severity Score, Glasgow Coma Scale motor component, hypotension, and mechanism of injury.
RESULTS
Patients meeting inclusion criteria numbered 760,598. Disparities between races-ethnicities/insurance groups increased as injury severity worsened. Odds of death for uninsured Black patients compared with insured Whites increased from 1.82 among moderately injured patients to 3.14 among severely injured, hypotensive patients. A similar pattern was seen among uninsured Hispanic patients.
CONCLUSIONS
Disparities in trauma mortality suffered by minority and uninsured patients, when compared with non-minority and insured patients, worsen with increasing injury.
目的
研究表明不同种族群体以及不同保险覆盖人群之间存在死亡率差异。我们的目标是确定损伤严重程度是否会影响这些差异。
方法
我们将2003 - 2008年国家创伤数据库中中度至重度损伤的患者根据种族/民族和保险情况分为六组，并按损伤严重程度进行分层。逻辑回归比较了这些分层中不同种族/民族/保险组之间的死亡几率。我们对年龄、性别、损伤严重程度评分、格拉斯哥昏迷量表运动评分、低血压和损伤机制进行了调整。
结果
符合纳入标准的患者有760,598例。随着损伤严重程度的加重，不同种族/民族/保险组之间的差异增大。未参保黑人患者与参保白人患者相比，中度损伤患者的死亡几率为1.82，而重度损伤、低血压患者的死亡几率增至3.14。未参保西班牙裔患者中也观察到类似模式。
结论
与非少数族裔和参保患者相比，少数族裔和未参保患者的创伤死亡率差异随着损伤加重而增大。
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