Division of Trauma and Acute Care Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Division of Trauma, Acute, and Critical Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
J Surg Res. 2020 Jan;245:198-204. doi: 10.1016/j.jss.2019.07.064. Epub 2019 Aug 14.
Race and insurance status have been shown to predict outcomes in pediatric bicycle traumas. It is unknown how these factors influence outcomes in adult bicycle traumas. This study aims to evaluate the association, if any, between race and insurance status with mortality in adults.
This retrospective cohort study used the National Trauma Data Bank Research Data Set for the years 2013-2015. Multivariate logistic regression models were used to determine the independent association between patient race and insurance status on helmet use and on outcomes after hospitalization for bicycle-related injury. These models adjusted for demographic factors and comorbid variables. When examining the association between race and insurance status with outcomes after hospitalization, injury characteristics were also included.
A study population of 45,063 met the inclusion and exclusion criteria. Multivariate regression demonstrated that black adults and Hispanic adults were significantly less likely to be helmeted at the time of injury than white adults [adjusted odds ratio of helmet use for blacks 0.25 (95% CI 0.22-0.28) and for Hispanics 0.33 (95% CI 0.30-0.36) versus whites]. Helmet usage was also independently associated with insurance status, with Medicare-insured patients [AOR 0.51 (95% CI 0.47-0.56) versus private-insured patients], Medicaid-insured patients [AOR 0.18 (95% CI 0.17-0.20)], and uninsured patients [AOR 0.29 (95% CI 0.27-0.32)] being significantly less likely to be wearing a helmet at the time of injury compared with private-insured patients. Although patient race was not independently associated with hospital mortality among adult bicyclists, we found that uninsured patients had significantly higher odds of mortality [AOR 2.02 (AOR 1.31-3.12)] compared with private-insured patients.
Minorities and underinsured patients are significantly less likely to be helmeted at the time of bicycle-related trauma when compared with white patients and those with private insurance. Public health efforts to improve the utilization of helmets during bicycling should target these subpopulations.
种族和保险状况已被证明可预测儿科自行车外伤的结果。尚不清楚这些因素如何影响成人自行车外伤的结果。本研究旨在评估种族和保险状况与成人自行车外伤死亡率之间的关联。
本回顾性队列研究使用了国家创伤数据银行研究数据集，研究年限为 2013-2015 年。多变量逻辑回归模型用于确定患者种族和保险状况与头盔使用以及因自行车相关损伤住院后的结果之间的独立关联。这些模型调整了人口统计学因素和合并变量。当检查种族和保险状况与住院后结果之间的关联时，还纳入了损伤特征。
符合纳入和排除标准的研究人群为 45063 人。多变量回归表明，与白人成年人相比，黑人成年人和西班牙裔成年人在受伤时戴头盔的可能性明显较低[黑人成年人使用头盔的调整优势比为 0.25（95%CI 0.22-0.28），西班牙裔成年人使用头盔的调整优势比为 0.33（95%CI 0.30-0.36）]。头盔的使用也与保险状况独立相关，医疗保险患者[优势比（AOR）0.51（95%CI 0.47-0.56）]、医疗补助保险患者[AOR 0.18（95%CI 0.17-0.20）]和无保险患者[AOR 0.29（95%CI 0.27-0.32）]在受伤时戴头盔的可能性明显低于私人保险患者。尽管患者种族与成人自行车骑手的医院死亡率无关，但我们发现，与私人保险患者相比，无保险患者的死亡率明显更高[AOR 2.02（95%CI 1.31-3.12）]。
与白人患者和私人保险患者相比，少数民族和未参保患者在发生与自行车相关的创伤时戴头盔的可能性明显较低。在骑自行车时提高头盔使用率的公共卫生工作应针对这些亚人群。
