Insurance Status, Not Race, Is a Determinant of Outcomes from Vehicular Injury
Insurance Status, Not Race, Is a Determinant of Outcomes from Vehicular Injury
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DOI：
10.1016/j.jamcollsurg.2010.12.016
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发表时间：
2011-04-01
影响因子：
5.2
通讯作者：
Flint, Lewis M.
中科院分区：
文献类型：
--
作者：
Tepas, Joseph J., III;Pracht, Etienne E.;Flint, Lewis M.
背景技术背景：假设特定损伤机制的结果不应因种族或社会经济地位而异，我们分析了2008年和2009年接受治疗的机动车碰撞受害者的种族和种族与死亡率的关系。研究设计：对合并的管理数据进行Logistic回归分析，评估患者人口统计学和损伤严重程度对结果的贡献，定义为急性住院期间的死亡率。人口统计学因素包括年龄、性别、人种、种族和保险。使用ICD-9损伤严重度评分（生存概率）p < 0.85、存在最多3种合并症和/或脊髓损伤和/或创伤性脑损伤的诊断来定义严重损伤。死亡率按到达创伤中心后24小时内或之后死亡的生存时间分层。结果的因素进行了测试，使用卡方分析计算模型estimate.RESULTS：为8,758机动车碰撞受害者在国家指定的创伤中心，年龄，性别，损伤严重程度，和2个或更多的合并症一致预测生存。种族和民族都与死亡风险增加无关。未投保与24小时内死亡相关（p < 0.001）。大多数在24小时内死亡的未投保者都有ICD-9损伤严重程度评分，
BACKGROUND: Hypothesizing that outcomes from specific injury mechanisms should not vary by race or socioeconomic status, we analyzed the relationship of race and ethnicity to fatality in motor vehicle crash victims treated during 2008 and 2009.STUDY DESIGN: Logistic regression analysis of pooled administrative data assessed the contribution of patient demographics and injury severity to outcome, defined as mortality during acute hospitalization. Demographic factors included age, sex, race, ethnicity, and insurance. Severe injury was defined using ICD-9 Injury Severity Score (survival probability) p < 0.85, presence of up to 3 comorbidities, and/or diagnosis of spinal cord injury and/or traumatic brain injury. Mortality was stratified by survival time after trauma center arrival to death within 24 hours or thereafter. Factors contributing to outcomes were tested using chi square analysis of the calculated model estimate.RESULTS: For 8,758 motor vehicle crash victims treated in state-designated trauma centers, age, sex, injury severity, and 2 or more comorbidities consistently predicted survival. Neither race nor ethnicity was associated with increased mortality risk. Being uninsured was related to death within 24 hours (p < 0.001). The majority of the uninsured who died within 24 hours had an ICD-9 Injury Severity Score p