Division of Trauma and Acute Care Surgery, Department of Surgery, Kendall Regional Medical Center, 11750 Bird Road, Miami, FL, 33175, USA.
Department of Mathematics, Nova Southeastern University, Fort Lauderdale, FL, USA.
World J Surg. 2020 Sep;44(9):3010-3021. doi: 10.1007/s00268-020-05591-2.
Although safeguards requiring emergency care are provided regardless of a patient's payor status, disparate outcomes have been reported in trauma populations. The purpose of this systematic review and meta-analysis was to determine whether race/ethnicity or insurance status had an effect on mortality and to systematically present the literature in the adult and pediatric trauma populations during the last decade.
An online search of PubMed, Cochrane Library, Google Scholar, and SAGE Journals was performed for publications from January 2009 to March 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used. The GRADE Working Group criteria were utilized to assess the evidence quality. A meta-analysis was conducted to compare mortality between insured/uninsured and Caucasian/non-Caucasian patients.
Our search revealed 680 publications that qualified for evaluation. Of these, 41 were included in the final analysis. Twenty-six studies included adults only, nine studies included pediatric patients only, and six studies evaluated both. Twelve studies evaluated the effects of race/ethnicity, 18 examined insurance status, and 11 investigated both. Uninsured patients had 22% greater odds of death than insured patients (OR 1.22; CI 1.21-1.24). Non-Caucasian patients had 18% greater risk of death than Caucasian patients (OR 1.18; CI 1.17-1.20).
Both the adult and pediatric trauma populations suffer outcome disparities based on race/ethnicity and insurance status. Overall, patients without insurance coverage and minority groups (i.e., non-Caucasians) had worse outcomes, as measured by odds of death and all-cause mortality.
尽管为无论患者支付者身份如何都提供了紧急护理保障，但在创伤人群中仍报告了不同的结果。本系统评价和荟萃分析的目的是确定种族/民族或保险状况是否对死亡率有影响，并在过去十年中系统地呈现成人和儿科创伤人群的文献。
在线搜索 PubMed、Cochrane 图书馆、Google Scholar 和 SAGE 期刊，以获取 2009 年 1 月至 2019 年 3 月期间的出版物。使用了系统评价和荟萃分析（PRISMA）指南的首选报告项目。使用 GRADE 工作组标准评估证据质量。进行荟萃分析以比较有保险/无保险和白种人/非白种人患者之间的死亡率。
我们的搜索发现有 680 篇符合评估条件的出版物。其中，41 篇被纳入最终分析。26 项研究仅包括成年人，9 项研究仅包括儿科患者，6 项研究同时评估了两者。12 项研究评估了种族/民族的影响，18 项研究检查了保险状况，11 项研究同时调查了两者。无保险的患者死亡的可能性比有保险的患者高 22%（OR 1.22；CI 1.21-1.24）。非白种人患者的死亡风险比白种人患者高 18%（OR 1.18；CI 1.17-1.20）。
基于种族/民族和保险状况，成人和儿科创伤人群都遭受了结果差异。总体而言，没有保险覆盖的患者和少数群体（即非白种人）的结局较差，死亡率和全因死亡率衡量。
