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A group of researcher from the Johns Hopkins School of Medicine Baltimore report that Blacks and Hispanics are more likely to die in U.S. emergency rooms after a trauma than white patients are. They found that 8.2 percent of blacks and 9.1 percent of Hispanics died in U.S. emergency rooms, compared with 5.7 percent of whites. In addition, 8.6 percent of uninsured patients died compared with 4.4 percent of insured patients.

Lead researcher Dr. Adil H. Haider said “Race and insurance status each independently predicts outcome disparities after trauma. African American, Hispanic, and uninsured patients have worse outcomes, but insurance status appears to have the stronger association with mortality after trauma.”

Compared with an insured white patient, equivalently injured black patients have 20 percent higher risk of dying, while Hispanic patients have a 51 percent increased odds of dying, Haider said. This problem is even worse for the uninsured, Haider said. “If we look at a similarly injured uninsured white patient, the odds of death go up by 55 percent. For uninsured minorities the odds of death go up even higher — 78 percent for blacks and 130 percent for Hispanics.”

This is the first large study that identifies differences in mortality rates based on race following trauma of all types. In this study both race and insurance status independently predicted mortality following trauma. The absence of health insurance increased a trauma patient’s adjusted odds of death by almost 50%. Of the insured patients, both Hispanic and African American patients had significantly higher odds of mortality compared with white patients. This confirms that racial disparities in trauma mortality cannot be completely explained by insurance status alone.

This study involved a retrospective analysis of trauma patients entered in the National Trauma Data Bank, version 6.1, between 2001 and 2005. The National Trauma Data Bank is maintained by the American College of Surgeons and is the largest repository of data on trauma inpatients in the United States, collecting data from approximately 700 trauma centers and hospitals that treat trauma patients.

Patients were grouped by self-reported race (African American, white, or Hispanic) and by insurance status of insured (commercial, health maintenance organization, workers compensation, managed care organization, Civilian Health and Medical Program of the Uniformed Services, automobile insurance, organ donor subsidy) or uninsured (Medicaid, self-paying, no insurance).

Access to trauma care is near universal in the United States, so these dramatic differences in patients with and without insurance are unexpected, Haider said. “The study also shows that there are racial disparities in survival after trauma, and differences in insurance between whites and minorities that cannot explain away these disparities,” he said. “Now that we know this, we can go about understanding exactly why these disparities exist and try to come up with solutions.”

Both race and insurance status independently influenced mortality after moderate to severe trauma in adults aged 18 to 64 years. This study refutes the notion that racial disparities are merely a reflection of insurance status differences. Understanding insurance and race-dependent differences is a crucial first step toward ameliorating health care disparities. The next step will be to comprehend the underlying reasons for these differences, which will enable the development of interventions to close the gap between patients of different races and payer statuses.

Source: Race and Insurance Status as Risk Factors for Trauma Mortality
Adil H. Haider, MD, MPH; David C. Chang, MPH, MBA, PhD; David T. Efron, MD; Elliott R. Haut, MD; Marie Crandall, MD, MPH; Edward E. Cornwell III, MD