Race and Insurance Status as Risk Factors for Trauma Mortality
Race and Insurance Status as Risk Factors for Trauma Mortality
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DOI：
10.1001/archsurg.143.10.945
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发表时间：
2008-10-01
影响因子：
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通讯作者：
Cornwell, Edward E., III
中科院分区：
文献类型：
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作者：
Haider, Adil H.;Chang, David C.;Cornwell, Edward E., III
目的：为了确定种族和保险状态对创伤mortality.Methods的影响：回顾国家创伤数据库（2001-2005）中的患者（年龄18-64岁;损伤严重程度评分9）。非裔美国人和西班牙裔患者分别与白色患者进行比较，保险患者与未保险患者进行比较。多元Logistic回归分析确定了调整人口统计学，损伤严重程度（损伤严重程度评分和修订的创伤评分），头部和/或四肢损伤的严重程度，损伤mechanism.Results：共429 751例患者符合纳入标准后的生存率差异。与白色患者（n = 262 878）相比，非裔美国人（n = 72 249）和西班牙裔（n = 41 770）患者不太可能投保，更可能遭受穿透性创伤。非裔美国人和西班牙裔患者的未校正死亡率较高（白色，5.7%;非裔美国人，8.7%）。2%;西班牙裔，9.1%;与白色患者相比，非裔美国人和西班牙裔患者的P = 0.05）和死亡的校正比值比（OR）增加（非裔美国人OR，1.17; 95%置信区间[CI]，1.10-1.23;西班牙裔OR，1.47; 95% CI，1.39-1.57）。投保患者（47%）的粗死亡率低于未投保患者（4.4% vs 8.6%; P = 0.05）。与投保的白色患者相比，投保的非裔美国人和西班牙裔患者的死亡率增加。这种影响在各组未投保的患者中恶化（有保险的非裔美国人OR，1.2; 95% CI，1.08-1.33;有保险的西班牙裔OR，1.51; 95% CI，1.36-1.64;无保险的白色OR，1.55; 95% CI，1.46-1.64;无保险的非裔美国人OR，1.78; 95% CI，1.65-1.90;无保险的西班牙裔OR，2.30; 95%CI，2.13-2.49）。参考组投保白色patients.Conclusion：种族和保险状态各自独立预测创伤后的结果差异。非裔美国人、西班牙裔和未投保的患者预后较差，但保险状况似乎与创伤后死亡率有更强的相关性。
Objective: To determine the effect of race and insurance status on trauma mortality.Methods: Review of patients (aged 18-64 years; Injury Severity Score 9) included in the National Trauma Data Bank (2001-2005). African American and Hispanic patients were each compared with white patients and insured patients were compared with uninsured patients. Multiple logistic regression analyses determined differences in survival rates after adjusting for demographics, injury severity (Injury Severity Score and revised Trauma Score), severity of head and/or extremity injury, and injury mechanism.Results: A total of 429 751 patients met inclusion criteria. African American (n = 72 249) and Hispanic (n = 41 770) patients were less likely to be insured and more likely to sustain penetrating trauma than white patients (n = 262 878). African American and Hispanic patients had higher unadjusted mortality rates (white, 5.7%; African American, 8..2%; Hispanic, 9.1%; P = .05 for African American and Hispanic patients) and an increased adjusted odds ratio (OR) of death compared with white patients (African American OR, 1.17; 95% confidence interval [CI], 1.10-1.23; Hispanic OR, 1.47; 95% CI, 1.39-1.57). Insured patients (47%) had lower crude mortality rates than uninsured patients (4.4% vs 8.6%; P = .05). Insured African American and Hispanic patients had increased mortality rates compared with insured white patients. This effect worsened for uninsured patients across groups (insured African American OR, 1.2; 95% Cl, 1.08-1.33; insured Hispanic OR, 1.51; 95% Cl, 1.36-1.64; uninsured white OR, 1.55; 95% Cl, 1.46-1.64; uninsured African American OR, 1.78; 95% CI, 1.65-1.90; uninsured Hispanic OR, 2.30; 95% CI, 2.13-2.49). The reference group was insured white patients.Conclusion: 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.