Newman-Plotnick Harry, Byrne James P, Haut Elliott Richard, Hultman Charles Scott
From the Division of Plastic and Reconstructive Surgery, Department of Surgery (H.N.-P.), Albany Medical Center, Albany, New York; Johns Hopkins Bloomberg School of Public Health (H.N.-P., E.R.H.); Division of Acute Care Surgery, Department of Surgery (J.P.B., E.R.H.), Johns Hopkins Medicine, Baltimore, Maryland; Division of General Surgery, Department of Surgery (J.P.B.), University of British Columbia, Vancouver, British Columbia, Canada; and Department of Plastic and Reconstructive Surgery (C.S.H.), WakeMed Health and Hospitals, Raleigh, North Carolina.
J Trauma Acute Care Surg. 2025 May 1;98(5):785-793. doi: 10.1097/TA.0000000000004512. Epub 2025 Jan 6.
While the United States has the highest incarceration rate worldwide, at nearly 1% of the adult population (more than 2 million people), insights regarding health disparities in this population remain limited. This retrospective cohort study represents the largest national database analysis of incarcerated trauma patients to date and investigates whether incarceration status is an independent risk factor for poor outcomes after trauma for US adults.
We analyzed data from the National Trauma Data Bank from 2017 to 2018. Using multilevel logistic regression, we measured risk-adjusted associations between incarceration status (assessed by International Classification of Diseases, Tenth Revision , location codes) and trauma outcomes: mortality, any in-hospital complications, aggregate major complications, and failure to rescue. We report odds ratios and 95% confidence intervals, adjusting for demographics, transfer status, insurance, comorbidities, injury mechanism, injury severity, and presenting vitals. A secondary analysis was performed using nearest neighbor matching with a 2:1 ratio of nonincarcerated to incarcerated patients, followed by multilevel logistic regression.
There were 12,888 incarcerated patients and 1,654,254 nonincarcerated patients. Incarcerated patients were younger (median, 36 vs. 55 years), more likely to be male (94.9% vs. 60.5%), Black (27.9% vs. 13.9%), and Hispanic (15.7% vs. 11.5%) and presented more frequently with minor injuries (Injury Severity Score, <9; 65.4% vs. 48.9%) and with stabbings and other blunt events as mechanisms of injury. Although unadjusted mortality was lower for incarcerated patients, after adjustment, they were significantly more likely to die (adjusted odds ratio (AOR), 1.42 [1.19-1.68]), which was consistent in the matched analysis (AOR, 1.19 [1.03-1.36]). Incarcerated patients were, conversely, less likely to suffer any in-hospital complication (AOR, 0.76 [0.68-0.85]; matched AOR, 0.88 [0.81-0.97]).
Our study redemonstrated that incarcerated trauma patients' demographics and injuries differ significantly from nonincarcerated patients. Furthermore, incarceration was an independent risk factor for mortality, a previously unreported disparity. This highlights the need for improved data collection regarding incarceration status and national prospective investigations.
Prognostic and Epidemiological; Level III.
美国是全球监禁率最高的国家，成年人口的监禁率近1%（超过200万人），但对这一人群健康差异的了解仍然有限。这项回顾性队列研究是迄今为止对成年创伤患者进行的最大规模的全国性数据库分析，旨在调查监禁状态是否是美国成年人创伤后不良结局的独立危险因素。
我们分析了2017年至2018年国家创伤数据库的数据。使用多水平逻辑回归，我们测量了监禁状态（通过国际疾病分类第十版位置编码评估）与创伤结局之间的风险调整关联：死亡率、任何院内并发症、总体主要并发症和抢救失败。我们报告比值比和95%置信区间，并对人口统计学、转运状态、保险、合并症、损伤机制、损伤严重程度和入院时生命体征进行了调整。使用非监禁患者与监禁患者比例为2:1的最近邻匹配进行了二次分析，随后进行多水平逻辑回归。
共有12888名监禁患者和1654254名非监禁患者。监禁患者更年轻（中位数分别为36岁和55岁），男性比例更高（94.9%对60.5%），黑人比例更高（27.9%对13.9%），西班牙裔比例更高（15.7%对11.5%），轻伤（损伤严重程度评分<9）以及刺伤和其他钝器伤作为损伤机制的情况更常见（65.4%对48.9%）。尽管未调整时监禁患者的死亡率较低，但调整后，他们死亡的可能性显著更高（调整后比值比[AOR]为1.42[1.19 - 1.68]），在匹配分析中也是如此（AOR为1.19[1.03 - 1.36]）。相反，监禁患者发生任何院内并发症的可能性较小（AOR为0.76[0.68 - 0.85]；匹配后的AOR为0.88[0.81 - 0.97]）。
我们的研究再次表明，监禁创伤患者的人口统计学特征和损伤情况与非监禁患者有显著差异。此外，监禁是死亡率的独立危险因素，这是一个此前未报告的差异。这突出了改善关于监禁状态的数据收集和全国前瞻性调查的必要性。
预后和流行病学；三级。
