Osler Turner, Glance Laurent G, Li Wenjun, Buzas Jeffery S, Wetzel Megan L, Hosmer David W
From the Department of Surgery (T.O.), Department of Mathematics and Statistics (J.S.B.), and College of Medicine (M.L.W.), University of Vermont, Colchester, Vermont; Department of Anesthesiology (L.G.G.), University of Rochester, Rochester, New York; Schools of Medicine (W.L.), and Public Health and Health Sciences (D.W.H.), University of Massachusetts, Worcester, Massachusetts.
J Trauma Acute Care Surg. 2015 May;78(5):1026-33. doi: 10.1097/TA.0000000000000593.
Previous studies have reported that black race and lack of health insurance coverage are associated with increased mortality following traumatic injury. However, the association of race and insurance status with trauma outcomes has not been examined using contemporary, national, population-based data.
We used data from the National Inpatient Sample on 215,615 patients admitted to 1 of 836 hospitals following traumatic injury in 2010. We examined the effects of race and insurance coverage on mortality using two logistic regression models, one for patients younger than 65 years and the other for older patients.
Unadjusted mortality was low for white (2.71%), black (2.54%), and Hispanic (2.03%) patients. We found no difference in adjusted survival for nonelderly black patients compared with white patients (adjusted odds ratio [AOR], 1.04; 95% confidence interval [CI], 0.90-1.19; p = 0.550). Elderly black patients had a 25% lower odds of mortality compared with elderly white patients (AOR, 0.75; 95% CI, 0.63-0.90; p = 0.002). After accounting for survivor bias, insurance coverage was not associated with improved survival in younger patients (AOR, 0.91; 95% CI, 0.77-1.07; p = 0.233).
Black race is not associated with higher mortality following injury. Health insurance coverage is associated with lower mortality, but this may be the result of hospitals' inability to quickly obtain insurance coverage for uninsured patients who die early in their hospital stay. Increasing insurance coverage may not improve survival for patients hospitalized following injury.
Epidemiologic and prognostic study, level III.
既往研究报道，黑人种族以及缺乏医疗保险与创伤性损伤后死亡率增加相关。然而，尚未使用当代全国性基于人群的数据来研究种族和保险状况与创伤结局之间的关联。
我们使用了2010年全国住院患者样本中836家医院之一收治的215,615例创伤性损伤患者的数据。我们使用两个逻辑回归模型研究种族和保险覆盖对死亡率的影响，一个针对65岁以下患者，另一个针对老年患者。
白人（2.71%）、黑人（2.54%）和西班牙裔（2.03%）患者的未调整死亡率较低。我们发现，与白人患者相比，非老年黑人患者的调整后生存率没有差异（调整优势比[AOR]，1.04；95%置信区间[CI]，0.90 - 1.19；p = 0.550）。与老年白人患者相比，老年黑人患者的死亡几率低25%（AOR，0.75；95% CI，0.63 - 0.90；p = 0.002）。在考虑幸存者偏差后，保险覆盖与年轻患者生存率的改善无关（AOR，0.91；95% CI，0.77 - 1.07；p = 0.233）。
黑人种族与损伤后较高死亡率无关。医疗保险覆盖与较低死亡率相关，但这可能是医院无法迅速为住院早期死亡的未参保患者获取保险覆盖的结果。增加保险覆盖可能无法改善创伤住院患者的生存率。
流行病学和预后研究，III级。
