title: Counting the lives lost: how many black trauma deaths are attributable to disparities?
abstract: BACKGROUND
  The number of black trauma deaths attributable to racial disparities is unknown. The objective of this study was to quantify the excess mortality experienced by black patients given disparities in the risk of mortality.
  
  
  METHODS
  We performed a retrospective analysis of patients aged 16-65 y with blunt and penetrating injuries, who were included in the National Trauma Data Bank from 2007-2010. Generalized linear modeling estimated the relative risk of death for black patients versus white patients, adjusting for known confounders. This analysis determined the difference in the observed number of black trauma deaths at Level I and II centers and the expected number of deaths if the risk of mortality for black patients had been equivalent to that of white patients.
  
  
  RESULTS
  A total of 1.06 million patients were included. Among patients with blunt and penetrating injuries at Level I trauma centers, white males and females had a relative risk of death of 0.82 (95% confidence interval [CI], 0.80-0.85) and 0.78 (95% CI, 0.74-0.83), respectively, compared with black patients. Similarly, at Level II trauma centers, white males and females had a relative risk of death of 0.84 (95% CI, 0.80-0.88) and 0.82 (95% CI, 0.73-0.91). Overall, of the estimated 41,613 deaths that occurred at Level I and II centers, 2206 (5.3%) were excess deaths among black patients.
  
  
  CONCLUSIONS
  Over a 4-y period, approximately 5% of trauma center deaths could be attributed to racial disparities in trauma outcomes. These data underscore the need to better understand and intervene against the mechanisms that lead to trauma outcomes disparities.
authors.affiliation: Center for Surgical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
authors.forename: Valerie K
authors.initials: VK
authors.lastname: Scott
authors.forename: Zain G
authors.initials: ZG
authors.lastname: Hashmi
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.forename: Xuan
authors.initials: X
authors.lastname: Hui
authors.forename: David T
authors.initials: DT
authors.lastname: Efron
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000401:mortality*; D014950:Wounds, Penetrating / Q000401:mortality*; D055815:Young Adult
keywords: Disparities; Mortality; Trauma outcomes