The influence of insurance, race, and gender on emergency department disposition.
OBJECTIVE
To examine the influence of insurance, race, and gender on the likelihood of hospitalization among trauma patients.


METHODS
Statewide hospital discharge and emergency department (ED) visit data collected between 1996 and 2000 were merged to examine factors that influence hospitalization among patients who sustained an injury. Multivariate logistic regression was used to model the likelihood of hospitalization as a function of patient, injury, and hospital characteristics.


RESULTS
Of 1,512,611 patients who presented to an ED in South Carolina for treatment of a traumatic injury during the five-year study period, 8% were hospitalized and 92% were treated and released. One fourth (26%) of the study population was uninsured. Insurance, race, and gender were significant predictors of hospitalization despite controlling for injury severity, comorbidities, age, trauma center level, place of residence, and year of injury. Regardless of injury severity, uninsured patients were significantly less likely to be hospitalized compared with privately insured patients (odds ratio [OR] 0.63, 99% CI = 0.62 to 0.65). Among those mildly to moderately injured, patients covered by Medicare or other government insurance policies were significantly more likely to be admitted compared with those with private coverage (OR 1.46, 99% CI = 1.41 to 1.52; OR 1.56, 99% CI = 1.36 to 1.78). Finally, among those mildly injured, African American females were significantly less likely to be admitted compared with white females (OR 0.63, 99% CI = 0.61 to 0.65).


CONCLUSIONS
These results suggest that the disposition of trauma patients from the ED may be influenced by insurance and demographic characteristics in addition to the patient's clinical condition.
Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston, SC 29425, USA. selassie@musc.edu
Anbesaw Wolde
AW
Selassie
Melissa Lee
ML
McCarthy
Emily Elisabeth
EE
Pickelsimer
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D013022:South Carolina; D014947:Wounds and Injuries / Q000145:classification / Q000628:therapy*