Insurance type is a determinant of 2-year mortality after non-neurologic trauma.
Insurance type is a determinant of 2-year mortality after non-neurologic trauma.
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保险类型是非神经性创伤后 2 年死亡率的决定因素。
DOI：
10.1016/j.jss.2009.06.059
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Fabian,TimothyC
中科院分区：
文献类型：
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作者：
Zarzaur,BenL;Stair,BradR;Magnotti,LouisJ;Croce,MartinA;Fabian,TimothyC
缺乏健康保险（NO-INS）与头部和脊髓损伤（NEURO-TRA）后的长期死亡率增加有关。关于保险类型和非NEURO-TRA后长期死亡率的影响知之甚少。我们假设NO-INS与中度至重度损伤后2年死亡率相关。方法2000-2005年，在I级创伤中心接受中度至重度钝性损伤（ISS>15）治疗且未使用NEURO-TRA且存活出院的成人（≥18岁）符合研究条件。使用社会保障管理局死亡主文件确定2年死亡率。Logistic回归分析用于确定保险类型[NO-INS、私人（PRIV-INS）、医疗保险/医疗补助（Medicare/Medicaid）、GOV-INS或其他（OTH-INS）]是否与2年死亡率相关。2年死亡风险为2.96%。单因素分析显示，入院年龄、乳酸水平和保险类型与2年死亡率相关（P<0.25）。但种族不是。调整入院年龄和乳酸后，与PRIV-INS相比，NO-INS或GOV-INS与2年死亡率增加显著相关。在没有符合医疗保险条件的患者（年龄≥65岁）中重复分析，GOV-INS仍与2年死亡率增加相关（OR 4.47 P<0.05）。结论在中度至重度钝性非NEURO-TRA后，GOVT-INS或NO-INS与2年死亡率增加相关。解释这种关联的机制尚不清楚。未来的研究重点是阐明不良长期结局背后的机制，应包括检查社会经济地位作为降低损伤后长期死亡率的潜在因素。
BACKGROUNDLack of health insurance (NO-INS) is associated with increased long-term mortality after head and spinal cord injuries (NEURO-TRA). Less is known about the influence of insurance type and long-term mortality following non-NEURO-TRA. We hypothesized that NO-INS would be associated with 2-y mortality after moderate to severe injury.METHODSAdults (≥18) treated at a level-I trauma center following a moderate to severe blunt injury (ISS>15) and without NEURO-TRA from 2000–2005 and discharged alive were eligible for the study. Two-y mortality was determined utilizing the Social Security Administration Death Master File. Logistic regression analysis was used to determine if type of insurance [NO-INS, Private (PRIV-INS), Medicare/Medicaid; GOV-INS), or Other (OTH-INS)] was related to 2-y mortality.RESULTSOne thousand nine hundred fifty-eight patients met study inclusion/exclusion criteria. Two-y risk of death was 2.96%. On univariate analysis, admission age, lactate, and insurance type were associated with 2-y mortality (P<0.25). However, race was not. After adjusting for admission age and lactate, compared with PRIV-INS, having either NO-INS or GOV-INS was significantly associated with increased 2-y mortality. The analysis was repeated without patients eligible for Medicare (Age≥65), and GOV-INS was still associated with increased 2-y mortality (OR 4.47 P<0.05).CONCLUSIONFollowing moderate to severe blunt, non-NEURO-TRA, having GOVT-INS or NO-INS was associated with increased 2-y mortality. The mechanism by which this association may be explained is unclear. Future research focused on elucidating mechanisms behind poor long-term outcomes should include an examination of socioeconomic status as a potential contributor to reduced long-term mortality after injury.