title: The influence of race and hospital environment on the care of patients with cervical spine fractures.
abstract: The influence of non-white race on outcomes following orthopedic injury has been described in the past. The impact of such factors on hospital processes and quality of care after spinal trauma is less well understood.
  
  
  
  A cohort control study using the Massachusetts Statewide Inpatient Dataset (2003-2010) was used as the study design.
  
  
  
  This study aimed to determine whether (1) hospital processes and quality of care associated with the treatment of cervical spine fractures was significantly altered by non-white race and (2) whether findings were different among those treated at academic medical centers (AMCs).
  
  
  
  The study comprised 10,841 patients.
  
  
  
  Surgical rate, postoperative morbidity, mortality, and length of stay (LOS) were the outcome measures.
  
  
  
  Baseline differences between cohorts were evaluated using chi-square or Wilcoxon rank sum tests. Logistic and negative binomial regression techniques were used to adjust for confounders, including whether a surgical intervention was performed. Subset analyses were performed to evaluate whether findings were different for individuals treated at AMCs.
  
  
  
  The rate of surgical intervention was not significantly different between non-whites and whites (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.82-1.04). LOS (regression coefficient [RC] 0.18, 95% CI 0.13-0.23), mortality (OR 1.49, 95% CI 1.20-1.85), and complications (OR 1.17, 95% CI 1.02-1.33) were significantly increased among non-white patients. These findings were largely preserved among those treated at AMCs.
  
  
  
  Our results reinforce the fact that efforts at universal access to care may be insufficient to reduce differences in care among minority patients following cervical trauma. Future mixed-methods research is necessary to more effectively evaluate the etiologies behind health-care disparities associated with race in different health-care environments.
  
  
  
  The level of evidence is Level III, prognostic study.
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA. Electronic address: ajschoen@neomed.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schoenfeld
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Dafang
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
authors.forename: Kempland C
authors.initials: KC
authors.lastname: Walley
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bono
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Mitchel B
authors.initials: MB
authors.lastname: Harris
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D015331:Cohort Studies; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D016103:Spinal Fractures / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy
keywords: Academic medical centers; African American; Cervical spine trauma; Complications; Disparities; Minorities; Mortality