title: Insurance-and race-related disparities decrease in elderly trauma patients.
abstract: BACKGROUND
  Little focus is on health care disparities in the elderly, a population largely covered by public insurance. We characterized insurance type and race in elderly trauma patients to determine if lack of insurance or minority status predict increased mortality.
  
  
  METHODS
  The National Trauma Data Bank (version 7.0) was queried for all adult blunt trauma patients. We divided patients into two cohorts (15-64 or ≥ 65 years) based on age for universal Medicare eligibility. Our primary outcome measure was in-hospital mortality. Multiple logistic regression was used to control for confounding variables.
  
  
  RESULTS
  A total of 541,471 patients met inclusion criteria. Among younger patients, the most common insurance type was private (41.0%), with 26.9% uninsured. In contrast, the most common insurance type among older patients was Medicare (64.6%), with 6.0% uninsured. Within the younger cohort, private insurance (adjusted odds ratio [AOR], 0.6; p < 0.01) and other insurance (AOR, 0.8; p < 0.01) predicted reduced mortality, while Medicare predicted similar mortality (AOR, 1.1; p = 0.18) compared with no insurance. Black race (AOR, 1.4; p < 0.01) and Hispanic ethnicity (AOR, 1.4; p < 0.01) predicted higher mortality compared with white race. Within the older cohort, no insurance predicted similar mortality as Medicare (AOR, 1.0; p = 0.43), private insurance (AOR, 1.0; p = 0.51), and other insurance (AOR, 1.0; p = 0.71). Hispanic ethnicity predicted increased mortality (AOR, 1.4; p < 0.01), while Asian race was protective (AOR, 0.7; p = 0.01) compared with white race.
  
  
  CONCLUSIONS
  Elderly trauma patients present primarily with Medicare, while younger trauma patients are mostly privately insured; elderly patients are four times more likely to be insured. Disparities caused by lack of insurance and minority race are reduced in elderly trauma patients.
  
  
  METHODS
  Epidemiologic/prognostic study, level III.
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Singer
authors.forename: Douglas Z
authors.initials: DZ
authors.lastname: Liou
authors.forename: Morgan A
authors.initials: MA
authors.lastname: Clond
authors.forename: Marko
authors.initials: M
authors.lastname: Bukur
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Margulies
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015600:Glasgow Coma Scale; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D017057:Medically Uninsured; D006278:Medicare; D008875:Middle Aged; D014481:United States; D014949:Wounds, Nonpenetrating / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D055815:Young Adult