title: The severity of disparity: increasing injury intensity accentuates disparate outcomes following trauma.
abstract: OBJECTIVE
  Studies have shown disparities in mortality among racial groups and among those with differing insurance coverage. Our goal was to determine if injury severity affects these disparities.
  
  
  METHODS
  We classified patients from the 2003-2008 National Trauma Data Banks suffering moderate to severe injuries into six groups based on race/ethnicity and insurance, stratifying by injury severity. Logistic regression compared odds of death between races-ethnicities/insurance groups within these strata. We adjusted for age, gender, Injury Severity Score, Glasgow Coma Scale motor component, hypotension, and mechanism of injury.
  
  
  RESULTS
  Patients meeting inclusion criteria numbered 760,598. Disparities between races-ethnicities/insurance groups increased as injury severity worsened. Odds of death for uninsured Black patients compared with insured Whites increased from 1.82 among moderately injured patients to 3.14 among severely injured, hypotensive patients. A similar pattern was seen among uninsured Hispanic patients.
  
  
  CONCLUSIONS
  Disparities in trauma mortality suffered by minority and uninsured patients, when compared with non-minority and insured patients, worsen with increasing injury.
authors: Lia I
authors: LI
authors: Losonczy
authors: P Logan
authors: PL
authors: Weygandt
authors: Cassandra V
authors: CV
authors: Villegas
authors: Erin C
authors: EC
authors: Hall
authors: Eric B
authors: EB
authors: Schneider
authors: Lisa A
authors: LA
authors: Cooper
authors: Edward E
authors: EE
authors: Cornwell
authors: Elliott R
authors: ER
authors: Haut
authors: David T
authors: DT
authors: Efron
authors: Adil H
authors: AH
authors: Haider
mesh_terms: D000293:Adolescent; D000328:Adult; D016208:Databases, Factual; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality*; D055815:Young Adult