title: Lower extremity vascular injuries: increased mortality for minorities and the uninsured?
abstract: BACKGROUND
  There is increasing evidence to suggest that racial disparities exist in outcomes for trauma. Minorities and the uninsured have been found to have higher mortality rates for blunt and penetrating trauma. However, mechanisms for these disparities are incompletely understood. Limiting the inquiry to a homogenous group, those with lower extremity vascular injuries (LEVIs), may clarify these disparities.
  
  
  METHODS
  The National Trauma Data Bank (NTDB; version 7.0, American College of Surgeons) was used for this study. LEVIs were identified using codes from the International Classification of Diseases, 9th revision. Univariate and multivariate analyses were performed using Stata software (version 11; StataCorp, LP, College Station, TX).
  
  
  RESULTS
  Records were reviewed for 4,928 LEVI patients. The mechanism of injury was blunt in 2,452 (49.8%), penetrating in 2,452 (49.8%), and unknown in 24 cases (0.5%). Mortality was similar by mechanism (7.6% overall). Regression analysis using mechanism as a covariate revealed a significantly worse mortality for people of color (POC; odds ratio [OR], 1.45; 95% confidence interval [CI], 1.03-2.02; P = .03) and the uninsured (UN; OR, 1.62; 95% CI, 1.15-2.23; P = .006). However, when separate analyses were performed stratifying by mechanism, no significant mortality disparities were found for blunt trauma (POC OR, 1.28; 95% CI, 0.85-1.96; P = .23; UN OR, 1.33; 95% CI, 0.78-2.22; P = .29), but disparities remained for penetrating trauma (POC OR, 1.81; 95% CI, 0.93-3.57; P = .08; UN OR, 1.85; 95% CI, 1.18-2.94; P = .009).
  
  
  CONCLUSIONS
  For patients with LEVI, mortality disparities based on race or insurance status were only observed for penetrating trauma. It is possible that injury heterogeneity or patient cohort differences may partly explain mortality disparities that have been observed between racial and socioeconomic groups.
authors: Department of Surgery at Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. mcrandall@northwestern.edu
authors: Marie
authors: M
authors: Crandall
authors: Douglas
authors: D
authors: Sharp
authors: Karen
authors: K
authors: Brasel
authors: Mercedes
authors: M
authors: Carnethon
authors: Adil
authors: A
authors: Haider
authors: Thomas
authors: T
authors: Esposito
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007869:Leg Injuries / Q000401:mortality*; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D008913:Minority Groups; D054525:Minority Health; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D057772:Vascular System Injuries / Q000401:mortality*; D014949:Wounds, Nonpenetrating / Q000401:mortality; D014950:Wounds, Penetrating / Q000401:mortality; D055815:Young Adult