title: Can universal coverage eliminate health disparities? Reversal of disparate injury outcomes in elderly insured minorities.
abstract: BACKGROUND
  Health outcome disparities in racial minorities are well documented. However, it is unknown whether such disparities exist among elderly injured patients. We hypothesized that such disparities might be reduced in the elderly owing to insurance coverage under Medicare. We investigated this issue by comparing the trauma outcomes in young and elderly patients in California.
  
  
  METHODS
  A retrospective analysis of the California Office of Statewide Health Planning and Development hospital discharge database was performed for all publicly available years from 1995 to 2008. Trauma admissions were identified by International Classification of Disease, Ninth Revision, primary diagnosis codes from 800 to 959, with certain exclusions. Multivariate analysis examined the adjusted risk of in-hospital mortality in young (<65 y) and elderly (≥65 y) patients, controlling for age, gender, injury severity as measured by the survival risk ratio, Charlson comorbidity index, insurance status, calendar year, and teaching hospital status.
  
  
  RESULTS
  A total of 1,577,323 trauma patients were identified. Among the young patients, the adjusted odds ratio of death relative to non-Hispanic whites for blacks, Hispanics, Asians, and Native Americans/others was 1.2, 1.2, 0.90, and 0.78, respectively. The corresponding adjusted odds ratios of death for elderly patients were 0.78, 0.87, 0.92, and 0.61.
  
  
  CONCLUSIONS
  Young black and Hispanic trauma patients had greater mortality risks relative to non-Hispanic white patients. Interestingly, elderly black and Hispanic patients had lower mortality risks compared with non-Hispanic whites.
authors.affiliation: Department of Surgery, University of California, San Diego, School of Medicine, San Diego, CA 92103-8402, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ramirez
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: Selwyn O
authors.initials: SO
authors.lastname: Rogers
authors.forename: Peter T
authors.initials: PT
authors.lastname: Yu
authors.forename: Molly
authors.initials: M
authors.lastname: Easterlin
authors.forename: Raul
authors.initials: R
authors.lastname: Coimbra
authors.forename: Leslie
authors.initials: L
authors.lastname: Kobayashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D006278:Medicare; D008875:Middle Aged; D008913:Minority Groups; D012189:Retrospective Studies; D014481:United States; D019472:Universal Health Insurance; D014947:Wounds and Injuries / Q000208:ethnology / Q000401:mortality*; D001741:Black or African American