title: Association between hospitals caring for a disproportionately high percentage of minority trauma patients and increased mortality: a nationwide analysis of 434 hospitals.
abstract: OBJECTIVE
  To determine whether there is an increased odds of mortality among trauma patients treated at hospitals with higher proportions of minority patients (ie, black and Hispanic patients combined).
  
  
  METHODS
  Hospitals were categorized on the basis of the percentage of minority patients admitted with trauma. The adjusted odds of in-hospital mortality were compared between hospitals with less than 25% of patients who were minorities (the reference group) and hospitals with 25% to 50% of patients who were minorities and hospitals with more than 50% of patients who were minorities. Multivariate logistic regression (with generalized linear modeling and a cluster-correlated robust estimate of variance) was used to control for multiple patient and injury severity characteristics.
  
  
  METHODS
  A total of 434 hospitals in the National Trauma Data Bank.
  
  
  METHODS
  Patients aged 18 to 64 years whose medical records were included in the National Trauma Data Bank for the years 2007 and 2008 with an Injury Severity Score of 9 or greater and who were white, black, or Hispanic.
  
  
  METHODS
  Crude mortality and adjusted odds of in-hospital mortality.
  
  
  RESULTS
  A total of 311,568 patients were examined. Hospitals in which the percentage of minority patients was more than 50% also had younger patients, fewer female patients, more patients with penetrating trauma, and the highest crude mortality. After adjustment for potential confounders, patients treated at hospitals in which the percentage of minority patients was 25% to 50% and at hospitals in which the percentage of minority patients was more than 50% demonstrated increased odds of death (adjusted odds ratio, 1.16 [95% confidence interval, 1.01-1.34] and adjusted odds ratio, 1.37 [95% confidence interval, 1.16-1.61], respectively), compared with the reference group. This disparity increased further on subset analysis of patients with a blunt injury. Uninsured patients had significantly increased odds of mortality within all 3 hospital groups.
  
  
  CONCLUSIONS
  Patients treated at hospitals with higher proportions of minority trauma patients have increased odds of dying, even after adjusting for potential confounders. Differences in outcomes between trauma hospitals may partly explain racial disparities.
authors.affiliation: Center for Surgery Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, 600 N Wolfe St, Halsted 610, Baltimore, MD 21212, USA. ahaider1@jhmi.edu
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
authors.forename: Sharon
authors.initials: S
authors.lastname: Ong'uti
authors.forename: David T
authors.initials: DT
authors.lastname: Efron
authors.forename: Tolulope A
authors.initials: TA
authors.lastname: Oyetunji
authors.forename: Marie L
authors.initials: ML
authors.lastname: Crandall
authors.forename: Valerie K
authors.initials: VK
authors.lastname: Scott
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People; D006630:Hispanic or Latino; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D008913:Minority Groups; D014481:United States; D044465:White People; D014947:Wounds and Injuries / Q000401:mortality*; D055815:Young Adult; D001741:Black or African American