title: Does insurance status matter at a public, level I trauma center?
abstract: BACKGROUND
  It has previously been demonstrated that a lack of insurance impedes access to health care services and may affect outcome after acute medical events. Very little data exists on the impact of insurance status on outcomes after traumatic injury. The purpose of this study was to determine whether insurance status has an impact on the outcomes of trauma patients admitted to a publicly funded county level I trauma center.
  
  
  METHODS
  This is a retrospective study of adult trauma patients (aged 18 years or older) admitted between January 1,1998, and December 31, 2005. Patients transferred out within 1 week of injury were excluded. Variables examined included demographics, insurance status, mechanism of injury, Injury Severity Score, Abbreviated Injury Scales, Glasgow Coma Scale, procedures performed, and outcomes. Logistic regression was used to determine independent risk factors for mortality.
  
  
  RESULTS
  Sixty-eight percent of the 29,829 patients admitted were uninsured. Uninsured patients were younger (36 versus 41, p < 0.0001) and less severely injured (Injury Severity Score 8 versus 10, p < 0.0001) but had a significantly higher mortality rate (7.0% versus 4.9%, p < 0.0001) compared with insured counterparts. Logistic regression identified uninsured status as an independent risk factor for mortality (AOR, 3.4; 95% confidence interval, 2.9-4.1; p < 0.0001). There was significant disparity between the mortality rates for uninsured and insured patients within the Black (7.1% versus 3.3%, p < 0.0001) and Hispanic (6.5% versus 4.1%, p < 0.0001) populations. No such mortality difference was observed in the white (7.2% versus 6.9%, p = 0.7) and Asian (9.7% versus 9.2%, p = 0.8) populations.
  
  
  CONCLUSIONS
  Despite being younger and less severely injured, uninsured trauma patients had a significantly higher mortality rate. The etiology of this discrepancy is unclear and warrants further investigation.
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Suite 8215N, Los Angeles, CA 90048, USA. ali.salim@cshs.org
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Marcus
authors.initials: M
authors.lastname: Ottochian
authors.forename: Joseph
authors.initials: J
authors.lastname: DuBose
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Pedro
authors.initials: P
authors.lastname: Teixeira
authors.forename: Linda S
authors.initials: LS
authors.lastname: Chan
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Margulies
mesh_terms: D000328:Adult; D001213:Asian; D044383:Black People; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006779:Hospitals, Public; D006801:Humans; D015141:Los Angeles; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology; D012307:Risk Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D001741:Black or African American