title: Not Just an Urban Phenomenon: Uninsured Rural Trauma Patients at Increased Risk for Mortality.
abstract: BACKGROUND
  National studies of largely urban populations showed increased risk of traumatic death among uninsured patients, as compared to those insured. No similar studies have been done for major trauma centers serving rural states.
  
  
  METHODS
  We performed retrospective analyses using trauma registry records from adult, non-burn patients admitted to a single American College of Surgeons-certified Level 1 trauma center in a rural state (2003-2010, n=13,680) and National Trauma Data Bank (NTDB) registry records (2002-2008, n=380,182). Risk of traumatic death was estimated using multivariable logistic regression analysis.
  
  
  RESULTS
  We found that 9% of trauma center patients and 27% of NTDB patients were uninsured. Overall mortality was similar for both (~4.5%). After controlling for covariates, uninsured trauma center patients were almost five times more likely to die and uninsured NTDB patients were 75% more likely to die than commercially insured patients. The risk of death among Medicaid patients was not significantly different from the commercially insured for either dataset.
  
  
  CONCLUSIONS
  Our results suggest that even with an inclusive statewide trauma system and an emergency department that does not triage by payer status, uninsured patients presenting to the trauma center were at increased risk of traumatic death relative to patients with commercial insurance.
authors.affiliation: University of Iowa, Department of Emergency Medicine, Iowa City, Iowa.
authors.forename: Azeemuddin
authors.initials: A
authors.lastname: Ahmed
authors.affiliation: University of Iowa, Department of Emergency Medicine, Iowa City, Iowa.
authors.forename: Karisa K
authors.initials: KK
authors.lastname: Harland
authors.affiliation: University of Iowa, Department of Emergency Medicine, Iowa City, Iowa.
authors.forename: Bryce
authors.initials: B
authors.lastname: Hoffman
authors.affiliation: University of Iowa, Department of Surgery, Iowa City, Iowa.
authors.forename: Junlin
authors.initials: J
authors.lastname: Liao
authors.affiliation: University of Iowa, Department of Surgery, Iowa City, Iowa.
authors.forename: Kent
authors.initials: K
authors.lastname: Choi
authors.affiliation: University of Iowa, Department of Surgery, Iowa City, Iowa.
authors.forename: Dionne
authors.initials: D
authors.lastname: Skeete
authors.affiliation: University of Iowa, Department of Emergency Medicine, Iowa City, Iowa.
authors.forename: Gerene
authors.initials: G
authors.lastname: Denning
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality*