title: The association between insurance status and emergency department disposition of injured California children.
abstract: OBJECTIVE
  This study examined the relationship between insurance status and emergency department (ED) disposition of injured California children.
  
  
  METHODS
  Multivariate regression models were built using data obtained from the 2005 through 2009 California Office of Statewide Health Planning and Development (OSHPD) data sets for all ED visits by injured children younger than 19 years of age.
  
  
  RESULTS
  Of 3,519,530 injury-related ED visits, 52% were insured by private, and 36% were insured by public insurance, while 11% of visits were not insured. After adjustment for injury characteristics and demographic variables, publicly insured children had a higher likelihood of admission for mild, moderate, and severe injuries compared to privately insured children (mild injury adjusted odds ratio [AOR] = 1.36, 95% confidence interval [CI] = 1.34 to 1.39; moderate and severe injury AOR = 1.34, 95% CI = 1.28 to 1.41). However, uninsured children were less likely to be admitted for mild, moderate, and severe injuries compared to privately insured children (mild injury AOR = 0.63, 95% CI = 0.61 to 0.66; moderate and severe injury AOR = 0.50, 95% CI = 0.46 to 0.55). While publicly insured children with moderate and severe injuries were as likely as privately insured children to experience an ED death (AOR = 0.91, 95% CI = 0.70 to 1.18), uninsured children with moderate and severe injuries were more likely to die in the ED compared to privately insured children (AOR = 3.11, 95% CI = 2.38 to 4.06).
  
  
  CONCLUSIONS
  Privately insured, publicly insured, and uninsured injured children have disparate patterns of ED disposition. Policy and clinical efforts are needed to ensure that all injured children receive equitable emergency care.
authors.affiliation: Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Anna Chen
authors.initials: AC
authors.lastname: Arroyo
authors.forename: N
authors.initials: N
authors.lastname: Ewen Wang
authors.forename: Olga
authors.initials: O
authors.lastname: Saynina
authors.forename: Jay
authors.initials: J
authors.lastname: Bhattacharya
authors.forename: Paul H
authors.initials: PH
authors.lastname: Wise
mesh_terms: D000293:Adolescent; D002140:California; D002648:Child; D002654:Child Care / Q000458:organization & administration*; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008483:Medical Assistance / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000191:economics*