Regional variation in hospital mortality and 30-day mortality for injured Medicare patients.
BACKGROUND
We sought to evaluate how survival of older patients with injuries differs by geographic region within the United States.


METHODS
We analyzed Medicare fee-for-service records for patients aged 65 years and older with principal injury diagnoses (ICD-9 800-959, excluding 905, 930-939, 958). Cases were classified by Maximum Abbreviated Injury Score (AISmax) and Charlson Comorbidity score (0, 1, 2, >or=3). Hospital mortality and 30-day mortality were modeled as functions of age, sex, AISmax, comorbidity, and geographic region (northeast, midwest, south, west).


RESULTS
Hospital and 30-day mortality were both higher with male sex and increased age, AISmax, or Charlson score. Adjusted hospital mortality was highest in the northeast and south, but 30-day adjusted mortality was lowest in the same two regions.


CONCLUSIONS
Regional differences in risk-adjusted hospital survival for older patients with injuries are different from regional differences in 30-day survival. Hospital mortality as an outcome for older injured patients should be interpreted cautiously.
Gorra
Adam S
AS
Department of Surgery, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA.
Clark
David E
DE
Mullins
Richard J
RJ
Delorenzo
Michael A
MA
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D020379:Risk Adjustment; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000401:mortality