title: Trends in racial disparities for injured patients admitted to trauma centers.
abstract: OBJECTIVE
  To determine whether outcome disparities between black and white trauma patients have decreased over the last 10 years.
  
  
  METHODS
  Pennsylvania Trauma Outcome Study.
  
  
  METHODS
  We performed an observational cohort study on 191,887 patients admitted to 28 Level 1 and Level II trauma centers. The main outcomes of interest were (1) death, (2) death or major complication, and (3) failure-to-rescue. Hospitals were categorized according to the proportion of black patients. Multivariate regression models were used to estimate trends in racial disparities and to assess whether the source of racial disparities was within or between hospitals.
  
  
  RESULTS
  Trauma patients admitted to hospitals with high concentrations of blacks (>20 percent) had a 45 percent higher odds of death (adj OR: 1.45, 95 percent CI: 1.09-1.92) and a 73 percent higher odds of death or major complication (adj OR: 1.73, 95 percent CI: 1.42-2.11) compared with patients admitted to hospitals treating low proportions of blacks. Blacks and whites admitted to the same hospitals had no difference in mortality (adj OR: 1.05, 95 percent CI: 0.87, 1.27) or death or major complications (adj OR: 1.01; 95 percent CI: 0.90, 1.13). The odds of overall mortality, and death or major complications have been reduced by 32 percent (adj OR: 0.68; 95 percent CI: 0.54-0.86) and 28 percent (adj OR: 0.72; 95 percent CI: 0.60-0.85) between 2000 and 2009, respectively. Racial disparities did not change over 10 years.
  
  
  CONCLUSIONS
  Despite the overall improvement in outcomes, the gap in quality of care between black and white trauma patients in Pennsylvania has not narrowed over the last 10 years. Racial disparities in trauma are due to the fact that black patients are more likely to be treated in lower quality hospitals compared with whites.
authors.affiliation: Department of Anesthesiology, University of Rochester School of Medicine, Rochester, NY.
authors.forename: Laurent G
authors.initials: LG
authors.lastname: Glance
authors.forename: Turner M
authors.initials: TM
authors.lastname: Osler
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
authors.forename: J Wayne
authors.initials: JW
authors.lastname: Meredith
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.forename: Feng
authors.initials: F
authors.lastname: Qian
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D012042:Registries; D014193:Trauma Centers; D044465:White People / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000150:complications* / Q000208:ethnology* / Q000401:mortality*
keywords: Race; disparities; trauma