Pedestrians struck by motor vehicles further worsen race- and insurance-based disparities in trauma outcomes: the case for inner-city pedestrian injury prevention programs.
BACKGROUND
Pedestrian trauma is the most lethal blunt trauma mechanism, and the rate of mortality in African Americans and Hispanics is twice that compared with whites. Whether insurance status and differential survival contribute to this disparity is unknown.


METHODS
This study is a review of vehicle-struck pedestrians in the National Trauma Data Bank, v7.0. Patients <16 years and > or =65 years, as well as patients with Injury Severity Score (ISS) <9, were excluded. Patients were categorized as white, African American, or Hispanic, and as privately insured, government insured, or uninsured. With white and privately insured patients as reference, logistic regression was used to evaluate mortality by race and insurance status after adjusting for patient and injury characteristics.


RESULTS
In all, 26,404 patients met inclusion criteria. On logistic regression, African Americans had 22% greater odds of mortality (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.06-1.41) and Hispanics had 33% greater odds of mortality (OR, 1.33; 95% CI, 1.14-1.54) compared with whites. Uninsured patients had 77% greater odds of mortality (OR, 1.77; 95% CI, 1.52-2.06) compared with privately insured patients.


CONCLUSIONS
African American and Hispanic race, as well as uninsured status, increase the risk of mortality after pedestrian crashes. Given the greater incidence of pedestrian crashes in minorities, this compounded burden of injury mandates pedestrian trauma prevention efforts in inner cities to decrease health disparities.
Maybury
Rubie Sue
RS
Department of Surgery, Georgetown University Hospital, Washington, DC, USA.
Bolorunduro
Oluwaseyi B
OB
Villegas
Cassandra
C
Haut
Elliott R
ER
Stevens
Kent
K
Cornwell
Edward E
EE
Efron
David T
DT
Haider
Adil H
AH
D000063:Accidents, Traffic / Q000191:economics / Q000401:mortality / Q000517:prevention & control* / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D001741:Black or African American; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D044465:White People; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D055815:Young Adult