Wyrick Jonathan M, Kalosza Brittany A, Coritsidis George N, Tse Raymond, Agriantonis George
Department of Surgery, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, New York.
Department of Surgery, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, New York.
J Surg Res. 2017 Jun 15;214:145-153. doi: 10.1016/j.jss.2017.02.006. Epub 2017 Feb 21.
Epidemiologic studies have shown that undocumented immigrants (UIs) display characteristics of having a low socioeconomic status and are primarily of ethnic minorities. These social determinants of health are known to be associated with diminished health care access and poor clinical outcomes. We therefore investigated the impact of documentation status on the clinical outcomes of patients with traumatic injuries.
We conducted a retrospective review of the trauma registry at our safety net institution for all adult patients who were admitted from 2010 to 2014. UIs were identified by the absence of a valid social security number within their medical records. Multivariate regression analysis was used to determine the impact of documentation status on in-hospital mortality, length of stay (LOS), and the odds of rehab placement.
4924 trauma patients met the study criteria, of which 1050 (21.3%) were UIs. There was no significant difference in mortality rates between the two populations. Multivariate regression analyses revealed a longer average LOS and a decreased likelihood for placement in an in-patient rehabilitation facility following hospitalization for UIs, even after accounting for insurance, age, injury severity, and other possible confounders known to affect these outcomes.
There was no association between in-hospital mortality and documentation status; however, UIs had a longer average LOS and were less likely to be placed into rehab following their hospitalization. A longer LOS and a decreased likelihood for rehabilitation placement suggest that disparities in trauma care exist for UIs, putting them at risk for worse clinical and functional outcomes.
流行病学研究表明，无证移民（UIs）具有社会经济地位低下的特征，且主要为少数族裔。众所周知，这些健康的社会决定因素与医疗保健机会减少和临床结果不佳有关。因此，我们调查了身份文件状况对创伤患者临床结果的影响。
我们对2010年至2014年期间入住我们安全网机构的所有成年患者的创伤登记进行了回顾性研究。通过病历中没有有效的社会保险号码来识别无证移民。使用多变量回归分析来确定身份文件状况对住院死亡率、住院时间（LOS）和康复安置几率的影响。
4924名创伤患者符合研究标准，其中1050名（21.3%）为无证移民。两组人群的死亡率没有显著差异。多变量回归分析显示，即使在考虑了保险、年龄、损伤严重程度以及其他已知会影响这些结果的可能混杂因素之后，无证移民住院后的平均住院时间更长，入住住院康复机构的可能性降低。
住院死亡率与身份文件状况之间没有关联；然而，无证移民的平均住院时间更长，住院后被安置到康复机构的可能性更小。住院时间延长和康复安置可能性降低表明，无证移民在创伤护理方面存在差异，这使他们面临临床和功能结果更差的风险。
