title: Socioeconomic disparity in inpatient mortality after traumatic injury in adults.
abstract: BACKGROUND
  Prior studies have demonstrated that race and insurance status predict inpatient trauma mortality, but have been limited by their inability to adjust for direct measures of socioeconomic status (SES) and comorbidities. Our study aimed to identify whether a relationship exists between SES and inpatient trauma mortality after adjusting for known confounders.
  
  
  METHODS
  Trauma patients aged 18-65 years with an Injury Severity Scores (ISS) of ≥9 were identified using the 2003-2009 Nationwide Inpatient Sample. Median household income (MHI) by zip code, available by quartiles, was used to measure SES. Multiple logistic regression analyses were performed to determine odds of inpatient mortality by MHI quartile, adjusting for ISS, type of injury, comorbidities, and patient demographics.
  
  
  RESULTS
  In all, 267,621 patients met inclusion criteria. Patients in lower wealth quartiles had significantly greater unadjusted inpatient mortality compared with the wealthiest quartile. Adjusted odds of death were also higher compared with the wealthiest quartile for Q1 (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.06-1.20), Q2 (OR, 1.09; 95% CI, 1.02-1.17), and Q3 (OR, 1.11; 95% CI, 1.04-1.19).
  
  
  CONCLUSIONS
  MHI predicts inpatient mortality after adult trauma, even after adjusting for race, insurance status, and comorbidities. Efforts to mitigate trauma disparities should address SES as an independent predictor of outcomes.
authors: Center for Surgical Trials and Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
authors: Mays T
authors: MT
authors: Ali
authors: Xuan
authors: X
authors: Hui
authors: Zain G
authors: ZG
authors: Hashmi
authors: Nitasha
authors: N
authors: Dhiman
authors: Valerie K
authors: VK
authors: Scott
authors: David T
authors: DT
authors: Efron
authors: Eric B
authors: EB
authors: Schneider
authors: Adil H
authors: AH
authors: Haider
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007297:Inpatients; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012923:Social Class; D014947:Wounds and Injuries / Q000401:mortality*
references: J Trauma Acute Care Surg. 2013 May;74(5):1195-205
references: 23609267
references: Cancer. 1977 Feb;39(2):467-77
references: 837332
references: Dialogues Clin Neurosci. 2012 Mar;14(1):77-89
references: 22577307
references: JAMA. 2011 Sep 7;306(9):942-51
references: 21900134
references: Acad Med. 2010 Mar;85(3):556-63
references: 20182138
references: Arch Surg. 2012 Jan;147(1):63-70
references: 21930976
references: Public Health Rep. 1960 Sep;75:841-51
references: 14430875
references: JAMA. 1993 Jun 23-30;269(24):3140-5
references: 8505817
references: J Gen Intern Med. 2007 Sep;22(9):1231-8
references: 17594129
references: Arch Surg. 2008 Oct;143(10):945-9
references: 18936372
references: Med Care. 2008 Feb;46(2):192-9
references: 18219248
references: Am J Surg. 2010 Apr;199(4):554-7
references: 20359573
references: Arch Intern Med. 2007 Jun 25;167(12):1233-9
references: 17592095
references: Accid Anal Prev. 2012 Mar;45:99-106
references: 22269490
references: Am J Public Health. 2000 Jan;90(1):70-7
references: 10630140
references: Perspect Biol Med. 2005 Winter;48(1 Suppl):S42-53
references: 15842086
references: Am J Public Health. 1992 Jun;82(6):816-20
references: 1585961
references: Am J Epidemiol. 1980 Apr;111(4):407-14
references: 7377183
references: Eur J Intern Med. 2011 Dec;22(6):547-53
references: 22075278
references: Am J Epidemiol. 1976 Jul;104(1):1-8
references: 779462
references: J Trauma. 2010 Jul;69(1):20-5
references: 20622574
references: J Trauma. 2011 Jan;70(1):130-4; discussion 134-5
references: 21217490
references: Am J Public Health. 2012 Nov;102(11):e84-92
references: 22994256