Document Detail

Insurance-and race-related disparities decrease in elderly trauma patients.
MedLine Citation:
PMID:  23147178     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Little focus is on health care disparities in the elderly, a population largely covered by public insurance. We characterized insurance type and race in elderly trauma patients to determine if lack of insurance or minority status predict increased mortality.
METHODS: The National Trauma Data Bank (version 7.0) was queried for all adult blunt trauma patients. We divided patients into two cohorts (15-64 or ≥ 65 years) based on age for universal Medicare eligibility. Our primary outcome measure was in-hospital mortality. Multiple logistic regression was used to control for confounding variables.
RESULTS: A total of 541,471 patients met inclusion criteria. Among younger patients, the most common insurance type was private (41.0%), with 26.9% uninsured. In contrast, the most common insurance type among older patients was Medicare (64.6%), with 6.0% uninsured. Within the younger cohort, private insurance (adjusted odds ratio [AOR], 0.6; p < 0.01) and other insurance (AOR, 0.8; p < 0.01) predicted reduced mortality, while Medicare predicted similar mortality (AOR, 1.1; p = 0.18) compared with no insurance. Black race (AOR, 1.4; p < 0.01) and Hispanic ethnicity (AOR, 1.4; p < 0.01) predicted higher mortality compared with white race. Within the older cohort, no insurance predicted similar mortality as Medicare (AOR, 1.0; p = 0.43), private insurance (AOR, 1.0; p = 0.51), and other insurance (AOR, 1.0; p = 0.71). Hispanic ethnicity predicted increased mortality (AOR, 1.4; p < 0.01), while Asian race was protective (AOR, 0.7; p = 0.01) compared with white race.
CONCLUSION: Elderly trauma patients present primarily with Medicare, while younger trauma patients are mostly privately insured; elderly patients are four times more likely to be insured. Disparities caused by lack of insurance and minority race are reduced in elderly trauma patients.
LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III.
Matthew B Singer; Douglas Z Liou; Morgan A Clond; Marko Bukur; James Mirocha; Daniel R Margulies; Ali Salim; Eric J Ley
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  74     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-28     Completed Date:  2013-03-21     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  312-6     Citation Subset:  AIM; IM    
Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
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MeSH Terms
Aged, 80 and over
Glasgow Coma Scale
Healthcare Disparities* / ethnology
Insurance Coverage*
Medically Uninsured
Middle Aged
United States
Wounds, Nonpenetrating / ethnology,  mortality,  therapy*
Young Adult
Comment In:
J Trauma Acute Care Surg. 2013 Aug;75(2):346-7   [PMID:  23887575 ]
J Trauma Acute Care Surg. 2013 Aug;75(2):347   [PMID:  23887576 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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