Morris Matthew C, Vearrier Laura, Kutcher Matthew E, Karimi Masoumeh, Faruque Fazlay, Severance Alyscia, Brassfield Michelle, Zhang Lei
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TS, United States; Vanderbilt Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States.
Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, United States.
Injury. 2025 May;56(5):112275. doi: 10.1016/j.injury.2025.112275. Epub 2025 Mar 18.
Racial and socioeconomic disparities in firearm homicide rates are well-established in the United States. However, findings have been mixed regarding disparities for in-hospital mortality among firearm injury patients. The aim of this study was to evaluate the extent of in-hospital mortality disparities and whether differences persist after adjusting for person- and place-based factors.
This retrospective analysis evaluated all pediatric and adult patients admitted to a single level I trauma center with a statewide catchment area from 2010 to 2020. Patients with assault-related firearm injuries were included; those with accidental or self-inflicted firearm injuries were excluded. The primary outcome was in-hospital mortality. Predictors included demographic (i.e., race, sex, age), socioeconomic (i.e., health insurance), injury (i.e., severity), and area-level (i.e., community distress, social vulnerability, rurality/urbanicity) characteristics.
The sample consisted of 2,081 patients with assault-related firearm injuries, including 1,836 Black patients (88 %) and 1,838 males (88 %). The mean age was 32.3 (SD=11.9) years. A smaller proportion of Black (19 %) compared to White (27 %) patients had health insurance coverage. Among injury patients, there were 210 firearm deaths (10 %). In logistic regression analyses adjusting for demographic, injury, and socioeconomic characteristics, both insured patients and those with unspecified insurance status had lower risk of mortality than uninsured patients; these differences in mortality risk remained after accounting for potential survivor bias. Contrary to expectation, there were no racial differences in mortality risk. In multilevel models accounting for nesting of patients within geographic areas (i.e., zip codes, counties), differences in mortality risk by insurance status remained after accounting for community distress, social vulnerability, and rurality/urbanicity. However, racial and area-level differences in mortality risk emerged after accounting for survivor bias.
The present findings are consistent with research showing lower in-hospital mortality among insured compared to uninsured trauma patients. Notably, this reduced mortality risk remained after controlling for important social determinants of trauma outcomes, and extended to patients with unspecified insurance status. Future research is needed to identify person- and place-based factors that could help to explain and mitigate differences in mortality risk based on insurance status.
在美国，枪支凶杀率方面的种族和社会经济差异已得到充分证实。然而，关于枪支伤患者住院死亡率差异的研究结果却参差不齐。本研究的目的是评估住院死亡率差异的程度，以及在调整基于个人和地点的因素后差异是否仍然存在。
这项回顾性分析评估了2010年至2020年期间收治于一家服务全州范围的一级创伤中心的所有儿科和成年患者。纳入与袭击相关的枪支伤患者；排除意外或自伤性枪支伤患者。主要结局是住院死亡率。预测因素包括人口统计学特征（即种族、性别、年龄）、社会经济特征（即医疗保险）、损伤特征（即严重程度）和地区层面特征（即社区困境、社会脆弱性、城乡属性）。
样本包括2081例与袭击相关的枪支伤患者，其中1836例为黑人患者（88%），1838例为男性患者（88%）。平均年龄为32.3（标准差=11.9）岁。与白人患者（27%）相比，有医疗保险的黑人患者比例较小（19%）。在受伤患者中，有210例死于枪支伤（10%）。在对人口统计学、损伤和社会经济特征进行调整的逻辑回归分析中，有保险的患者和保险状况未明确的患者的死亡风险均低于未参保患者；在考虑潜在的幸存者偏倚后，这些死亡风险差异仍然存在。与预期相反，死亡风险不存在种族差异。在考虑患者在地理区域（即邮政编码、县）内的嵌套情况的多层次模型中，在考虑社区困境、社会脆弱性和城乡属性后，保险状况导致的死亡风险差异仍然存在。然而，在考虑幸存者偏倚后，出现了死亡风险的种族和地区层面差异。
本研究结果与其他研究一致，表明参保创伤患者的住院死亡率低于未参保患者。值得注意的是，在控制了创伤结局的重要社会决定因素后，这种降低的死亡风险仍然存在，并且扩展到保险状况未明确的患者。未来需要开展研究，以确定基于个人和地点的因素，这些因素有助于解释和减轻基于保险状况的死亡风险差异。
