New Mexico Department of Health, Santa Fe, New Mexico, United States of America.
PLoS One. 2024 Feb 15;19(2):e0298886. doi: 10.1371/journal.pone.0298886. eCollection 2024.
Persistent disparities in trauma in-hospital mortality owing to insurance status and race remain a prominent issue within healthcare. This study explores the relationships among insurance status, race, length of stay (LOS) in-hospital mortality outcomes in trauma patients at extreme risk of mortality (EROM) trauma patients.
Data was retrieved from the National Inpatient Sample, focusing on high-acuity trauma patients from 2007 to 2020, aged 18-64 years. Patients were identified using specific All Patient Refined Diagnosis Related Groups codes. Emphasis was placed on those with EROM owing to their resource-intensive nature and the potential influence of insurance on outcomes. Patients aged 65 years or older were excluded owing to distinct trauma patterns, as were those diagnosed with burns or non-trauma conditions.
The study encompassed 70,381 trauma inpatients with EROM, representing a national estimate of 346,659. Being insured was associated with a 34% decrease in the odds of in-hospital mortality compared to being uninsured. The in-hospital mortality risk associated with insurance status varied over time, with insurance having no impact on in-hospital mortality during hospitalizations of less than 2 days (short LOS). In the overall group, Black patients showed an 8% lower risk of in-hospital mortality compared to White patients, while they experienced a 33% higher risk of in-hospital mortality during short LOS.
Insured trauma inpatients demonstrated a significant reduction in the odds of in-hospital mortality compared to their uninsured counterparts, although this advantage was not present in the short LOS group. Black patients experienced lower in-hospital mortality rates compared to White patients, but this trend reversed in the short LOS group. These findings underscore the intricate relationships between insurance status, race, and duration of hospitalization, highlighting the need for interventions to improve patient outcomes.
由于保险状况和种族，创伤院内死亡率持续存在差异，这仍然是医疗保健领域的一个突出问题。本研究探讨了保险状况、种族与创伤极高危患者（EROM）的住院死亡率之间的关系。
从国家住院患者样本中提取数据，重点关注 2007 年至 2020 年期间 18-64 岁的高风险创伤患者。使用特定的所有患者精炼诊断相关组代码对患者进行识别。重点关注那些因资源密集型性质和保险对结果的潜在影响而导致 EROM 的患者。排除年龄在 65 岁或以上的患者，因为他们的创伤模式不同，以及那些被诊断患有烧伤或非创伤性疾病的患者。
这项研究包括 70381 名患有 EROM 的创伤住院患者，这代表了全国 346659 例的估计值。与没有保险的患者相比，有保险的患者院内死亡率的几率降低了 34%。保险状况与院内死亡率的相关性随时间而变化，在住院时间少于 2 天（短 LOS）的情况下，保险对院内死亡率没有影响。在总体人群中，与白人患者相比，黑人患者的院内死亡率风险降低了 8%，而在短 LOS 期间，他们的院内死亡率风险增加了 33%。
与没有保险的患者相比，有保险的创伤住院患者的院内死亡率几率显著降低，尽管在短 LOS 组中没有这种优势。与白人患者相比，黑人患者的院内死亡率较低，但这种趋势在短 LOS 组中发生了逆转。这些发现强调了保险状况、种族和住院时间之间的复杂关系，突出了需要干预措施来改善患者的结果。
