title: Trauma care does not discriminate: The association of race and health insurance with mortality following traumatic injury.
abstract: BACKGROUND
  Previous studies have reported that black race and lack of health insurance coverage are associated with increased mortality following traumatic injury. However, the association of race and insurance status with trauma outcomes has not been examined using contemporary, national, population-based data.
  
  
  METHODS
  We used data from the National Inpatient Sample on 215,615 patients admitted to 1 of 836 hospitals following traumatic injury in 2010. We examined the effects of race and insurance coverage on mortality using two logistic regression models, one for patients younger than 65 years and the other for older patients.
  
  
  RESULTS
  Unadjusted mortality was low for white (2.71%), black (2.54%), and Hispanic (2.03%) patients. We found no difference in adjusted survival for nonelderly black patients compared with white patients (adjusted odds ratio [AOR], 1.04; 95% confidence interval [CI], 0.90-1.19; p = 0.550). Elderly black patients had a 25% lower odds of mortality compared with elderly white patients (AOR, 0.75; 95% CI, 0.63-0.90; p = 0.002). After accounting for survivor bias, insurance coverage was not associated with improved survival in younger patients (AOR, 0.91; 95% CI, 0.77-1.07; p = 0.233).
  
  
  CONCLUSIONS
  Black race is not associated with higher mortality following injury. Health insurance coverage is associated with lower mortality, but this may be the result of hospitals' inability to quickly obtain insurance coverage for uninsured patients who die early in their hospital stay. Increasing insurance coverage may not improve survival for patients hospitalized following injury.
  
  
  METHODS
  Epidemiologic and prognostic study, level III.
authors.affiliation: From the Department of Surgery (T.O.), Department of Mathematics and Statistics (J.S.B.), and College of Medicine (M.L.W.), University of Vermont, Colchester, Vermont; Department of Anesthesiology (L.G.G.), University of Rochester, Rochester, New York; Schools of Medicine (W.L.), and Public Health and Health Sciences (D.W.H.), University of Massachusetts, Worcester, Massachusetts.
authors.forename: Turner
authors.initials: T
authors.lastname: Osler
authors.forename: Laurent G
authors.initials: LG
authors.lastname: Glance
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Buzas
authors.forename: Megan L
authors.initials: ML
authors.lastname: Wetzel
authors.forename: David W
authors.initials: DW
authors.lastname: Hosmer
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology*; D008875:Middle Aged; D011379:Prognosis; D044469:Racial Groups; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000191:economics / Q000208:ethnology / Q000628:therapy*