Racial disparities in mortality among adults hospitalized after injury.
BACKGROUND
Injury is a major cause of death in adults. Although racial disparities in healthcare access and health outcomes are well documented for medical conditions, the influence of race on access to emergent care after injury has received little scrutiny.


OBJECTIVE
We sought to determine whether race was associated with risk of in-hospital death after injury.


METHODS
Data from the Healthcare Cost and Utilization Project (1998-2002) were used to estimate multivariate models of in-hospital mortality, controlling for age, race, gender, comorbid conditions, injury severity, primary payer, median income of zip code of residence, and hospital type. Additional multivariate models were estimated among stratified subsets of patients, including injury severity and hospital type.


METHODS
Patients age 18-64 with a primary diagnosis of injury.


RESULTS
Relative to injured white patients, black and Asian patients had a higher risk of death [1.5% vs. 2.1% and 2.0%, multivariate odds ratios (OR) = 1.14 and 1.39]. Other racial/ethnic groups showed no significant mortality difference from white patients. In stratified analyses, we found large black-white mortality disparities among mild to moderately injured patients (OR = 1.40, 95% confidence interval: 1.18-1.66), whereas Asian-white disparities were concentrated among more severely injured patients (OR = 1.37, 95% confidence interval: 1.03-1.80).


CONCLUSIONS
Black and Asian patients have a higher risk of death after injury than white patients. These data raise important questions about access to quality trauma care for racial minority patients.
Arthur
Melanie
M
Department of Sociology, Portland State University, Portland, Oregon, USA. ffmma@uaf.edu
Hedges
Jerris R
JR
Newgard
Craig D
CD
Diggs
Brian S
BS
Mullins
Richard J
RJ
D000328:Adult; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D054624:Health Status Disparities; D054625:Healthcare Disparities; D017052:Hospital Mortality / Q000208:ethnology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011787:Quality of Health Care; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000145:classification / Q000208:ethnology / Q000401:mortality*