Disparities in trauma care and outcomes in the United States: a systematic review and meta-analysis.
Disparities in trauma care and outcomes in the United States: a systematic review and meta-analysis.
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DOI：
10.1097/ta.0b013e31828c331d
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发表时间：
2013-05
期刊：
影响因子：
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通讯作者：
Cooper LA
中科院分区：
文献类型：
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作者：
Haider AH;Weygandt PL;Bentley JM;Monn MF;Rehman KA;Zarzaur BL;Crandall ML;Cornwell EE;Cooper LA
种族和社会经济差距是普遍存在的，并在我们的医疗保健系统中持续存在。尽管创伤具有即时性，而且人们认为获得紧急护理的机会平等，但在创伤后的结果中也发现了不平等。我们的目的是系统地评价目前关于创伤死亡率与种族、保险状况和社会经济地位之间关系的文献。我们的次要目的是评估调查这些结果差异的潜在机制的数据。我们进行了系统回顾和随机效应荟萃分析，以检查创伤与种族，保险和社会经济差异之间的关系，发表于1990年4月至2011年10月。使用科克伦综述手册和流行病学观察性研究的荟萃分析（MOOSE）声明作为指南。最终审查纳入了35项研究。目前的文献表明，无保险状态是创伤结局的一个独立的负面预测因素。我们的荟萃分析证实了这一点，表明未投保的患者比私人保险的患者更容易死亡（OR 2.17 95%CI 1.51-3.11）。与白人相比，黑人患者在创伤结局方面存在种族差异。我们的荟萃分析表明，与白色人种相比，黑人与更高的死亡几率相关（OR 1.19，95%CI 1.09 - 1.31）。然而，比较西班牙裔和白色非西班牙裔患者创伤后死亡率结果的研究提供了相互矛盾的结果。我们的荟萃分析发现，西班牙裔患者与白色患者相比，死亡率无显著差异（OR 1.08，95%CI 0.99-1.18）。种族/民族和保险均与创伤后不同的结局明显相关。这些差异可能是由于创伤护理连续体中的多种因素造成的：宿主因素、院前因素、医院/提供者因素以及与急性期后护理和康复相关的因素。虽然有许多拟议的机制，我们认为，有几个干预措施，可以特别有效地打击创伤的差距。这些措施包括针对弱势群体的创伤预防计划，扩大医疗保健覆盖面，搬迁创伤中心以更好地为弱势群体提供服务，以及重组临床培训以解决隐性偏见。虽然仍有许多工作要充分阐明创伤差异的机制，但我们现在可以而且应该采取行动，开始减少或消除这些仍然困扰着我们医疗保健系统的差异。两个.
Race and socioeconomic disparities are pervasive and persist throughout our health care system. Inequities have also been identified in outcomes after trauma despite its immediate nature and the perceived equal access to emergent care. Our objective was to systematically evaluate the current literature on the association between trauma mortality and race, insurance status, and socioeconomic status. Our secondary objective was to assess data investigating potential mechanisms underlying these outcome disparities. We performed a systematic review and random effects meta-analysis to examine the relationship between trauma and race, insurance, and socioeconomic disparities published between April 1990 and October 2011. The Cochrane Review Handbook and the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) statement were used as guides. Thirty-five studies were included in the final review. The current body of literature indicates that uninsured status is an independent negative predictor of trauma outcomes. Our meta-analysis corroborated this by demonstrating that uninsured patients were more likely to die than privately insured patients (OR 2.17 95% CI 1.51–3.11). Racial disparities in trauma outcomes are shown to be present and independent for black patients compared to whites. Our meta-analysis demonstrated that black race was associated with higher odds of death when compared with white race (OR 1.19 95% CI 1.09 – 1.31). Studies comparing Hispanic and white non-Hispanic patients’ post-trauma mortality outcomes, however, have provided conflicting results. Our meta-analysis found no significant difference in mortality comparing Hispanic patients with white patients (OR 1.08 95% CI 0.99–1.18) Both race/ethnicity and insurance are clearly associated with disparate outcomes following trauma. These disparities are likely due to myriad factors across the trauma continuum of care: host factors, prehospital factors, hospital/provider factors, and factors associated with postacute care and rehabilitation. While there are many proposed mechanisms, we believe that there are several interventions that could be particularly effective in combatting trauma disparities. These include trauma prevention programs targeting vulnerable populations, expansion of healthcare coverage, relocation of trauma centers to better provide for vulnerable populations, and restructuring clinical training to address implicit biases. While much work still remains to fully elucidate the mechanisms underlying trauma disparities, we can and should now act to begin to reduce or eliminate these disparities that still plague our healthcare system. Two.