Chun Magnus, Zhang Yichi, Nguyen An, Becnel Chad, Noguera Valeria, Taghavi Sharven, Guidry Chrissy, Hussein Mohammed, Toraih Eman, McGrew Patrick
Department of Surgery, 12255Tulane University School of Medicine, New Orleans, LA, USA.
Department of Histology and Cell Biology, Genetics Unit, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Am Surg. 2022 May;88(5):859-865. doi: 10.1177/00031348211032592. Epub 2021 Jul 14.
Studies showed that a lack of insurance is associated with worse trauma outcomes. We examine insurance status and trauma mortality in a diverse metropolitan city and hypothesize that the higher risk of mortality in uninsured patients is due to insurance status and other factors.
A retrospective analysis of patients admitted to a Level 1 Trauma center for emergent surgery in a diverse metropolitan city from Jan 2016-May 2020 was conducted. Patients of different insurance statuses were analyzed for their injury mechanism and surgical intervention outcomes. Multivariate logistic regression was performed and the results were presented as odds ratio with 95% confidence intervals and values. Statistical significance was set at < .05.
738 patients met study criteria. Medicaid patients made up the largest proportions of injury mechanisms: 65.1% of gunshot wound cases, sharp object (41.7%), and falls (32.5%). Private insurance (OR = .13, 95% CI: .05-.35, = .000), Medicaid (OR = .19, 95% CI: .10-.35, = .000), Medicare (OR = .65, 95% CI: 0.28-1.51, = .31), and other insurance (OR = .44, 95% CI 0.22-.87, = .01) were associated with survival. Uninsured patients had the highest mortality rate resulting from trauma at 32.6% ( < .001), and the lowest mortality rate belonged to the private insurance cohort (6.3%, < .001). Uninsured patients accounted for 10.5% of gunshot wound cases, 8.5% of motor vehicle accident cases, 25% of sharp object cases, and 6.6% of falls.
Being uninsured was independently associated with mortality, while having insurance improved outcomes. Underlying mechanisms should be further elucidated to improve health equity and trauma outcomes in diverse patient populations.
研究表明，缺乏保险与更差的创伤治疗结果相关。我们在一个多元化的大都市中研究保险状况与创伤死亡率，并假设未参保患者较高的死亡风险是由保险状况及其他因素导致的。
对2016年1月至2020年5月期间在一个多元化大都市的一级创伤中心因急诊手术入院的患者进行回顾性分析。分析不同保险状况患者的损伤机制和手术干预结果。进行多因素逻辑回归分析，结果以比值比及95%置信区间和P值表示。设定P <.05为具有统计学意义。
738例患者符合研究标准。医疗补助患者在损伤机制中占比最大：枪伤病例的65.1%、锐器伤（41.7%）和跌倒（32.5%）。私人保险（比值比 = 0.13，95%置信区间：0.05 - 0.35，P = 0.000）、医疗补助（比值比 = 0.19，95%置信区间：0.10 - 0.35，P = 0.000）、医疗保险（比值比 = 0.65，95%置信区间：0.28 - 1.51，P = 0.31）和其他保险（比值比 = 0.44，95%置信区间0.22 - 0.87，P = 0.01）与生存相关。未参保患者因创伤导致的死亡率最高，为32.6%（P <.001），而死亡率最低的是私人保险队列（6.3%，P <.001）。未参保患者占枪伤病例的10.5%、机动车事故病例的8.5%、锐器伤病例的25%和跌倒病例的6.6%。
未参保与死亡率独立相关，而参保可改善治疗结果。应进一步阐明潜在机制，以改善不同患者群体的健康公平性和创伤治疗结果。
