title: Insurance type is a determinant of 2-year mortality after non-neurologic trauma.
abstract: BACKGROUND
  Lack of health insurance (NO-INS) is associated with increased long-term mortality after head and spinal cord injuries (NEURO-TRA). Less is known about the influence of insurance type and long-term mortality following non-NEURO-TRA. We hypothesized that NO-INS would be associated with 2-y mortality after moderate to severe injury.
  
  
  METHODS
  Adults (>or=18) treated at a level-I trauma center following a moderate to severe blunt injury (ISS>15) and without NEURO-TRA from 2000-2005 and discharged alive were eligible for the study. Two-y mortality was determined utilizing the Social Security Administration Death Master File. Logistic regression analysis was used to determine if type of insurance [NO-INS, Private (PRIV-INS), Medicare/Medicaid; GOV-INS), or Other (OTH-INS)] was related to 2-y mortality.
  
  
  RESULTS
  One thousand nine hundred fifty-eight patients met study inclusion/exclusion criteria. Two-y risk of death was 2.96%. On univariate analysis, admission age, lactate, and insurance type were associated with 2-y mortality (P<0.25). However, race was not. After adjusting for admission age and lactate, compared with PRIV-INS, having either NO-INS or GOV-INS was significantly associated with increased 2-y mortality. The analysis was repeated without patients eligible for Medicare (Age>or=65), and GOV-INS was still associated with increased 2-y mortality (OR 4.47 P<0.05).
  
  
  CONCLUSIONS
  Following moderate to severe blunt, non-NEURO-TRA, having GOVT-INS or NO-INS was associated with increased 2-y mortality. The mechanism by which this association may be explained is unclear. Future research focused on elucidating mechanisms behind poor long-term outcomes should include an examination of socioeconomic status as a potential contributor to reduced long-term mortality after injury.
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. bzarzaur@utmem.edu
authors.forename: Ben L
authors.initials: BL
authors.lastname: Zarzaur
authors.forename: Brad R
authors.initials: BR
authors.lastname: Stair
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Magnotti
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012923:Social Class; D014481:United States / Q000453:epidemiology; D019131:United States Social Security Administration / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000401:mortality*; D055815:Young Adult