title: Insurance coverage is associated with mortality after gunshot trauma.
abstract: BACKGROUND
  Poor access to adequate health care coverage is associated with poor outcomes for many chronic medical conditions. We hypothesized that insurance coverage is also associated with mortality after gunshot trauma.
  
  
  METHODS
  The trauma records for gunshot victims and their insurance status were reviewed at our center from January 1998 to December 2007. Patient demographics (age, gender, race, and insurance coverage), injury severity, hospital care (operations and radiographic studies), and in-hospital mortality were analyzed.
  
  
  RESULTS
  There were 2,164 gunshot trauma activations reviewed during the study period. One-quarter (n = 544) of these patients had insurance and three-quarters (n = 1,620) were uninsured. The in-hospital mortality rate was significantly higher for uninsured patients than for insured patients (9% vs 6%, p = 0.02). After controlling for age, gender, race, and injury severity by logistic regression analysis, the odds ratio for death of uninsured patients was 2.2 (95% CI 1.1 to 4.5). Insured patients did not differ from uninsured patients with respect to mean Injury Severity Score ([ISS] 12.2 +/- 10.7 vs 12.6 +/- 12.4, p = 0.56); similar percentages of patients were severely injured (ISS 16 to 24, 17% vs 15%, p = 0.19) and most severely injured (ISS > 24, 15% vs 16%, p = 0.68). Insured patients did not differ from uninsured patients with respect to use of radiographic imaging (53% vs 50%, p = 0.15) or operative intervention (37% vs 35%, p = 0.35).
  
  
  CONCLUSIONS
  Despite similar injury severity, uninsured trauma patients were more likely to die after gunshot injury than insured patients. This difference could not be attributed to demographics or hospital resource use. Insurance coverage may reflect the many social determinants of health. Improving the social determinants of health in patients affected by violent trauma may be a step toward improving outcomes after trauma.
authors.affiliation: Department of Surgery, University of California, San Francisco - East Bay Alameda County Medical Center, Oakland, CA.
authors.forename: Kristopher C
authors.initials: KC
authors.lastname: Dozier
authors.forename: Marvin A
authors.initials: MA
authors.lastname: Miranda
authors.forename: Rita O
authors.initials: RO
authors.lastname: Kwan
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Cureton
authors.forename: Javid
authors.initials: J
authors.lastname: Sadjadi
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Victorino
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006297:Health Services Accessibility; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D014948:Wounds, Gunshot / Q000401:mortality*