title: Impact of Type of Health Insurance on Infection Rates among Young Trauma Patients.
abstract: BACKGROUND
  Many studies have described the detrimental effect of lack of health insurance on trauma-related outcomes. It is unclear, though, whether these effects are related to pre-injury health status, access to trauma centers, or differences in quality of care after presentation. The aim of this study was to determine if patient and insurance type affect outcomes after trauma surgery.
  
  
  METHODS
  We conducted a retrospective chart review of prospectively collected data at the American College of Surgeons level 1 trauma registry in Rhode Island. All blunt trauma patients aged 18-45 observed from 2004 to 2014 were included. Patients were divided into one of four groups on the basis of their type of insurance: Private/commercial, Medicare, Medicaid, and uninsured. Co-morbidities and infections were recorded. Analysis of variance or the Mann-Whitney U test, as appropriate, was used to analyze the data.
  
  
  RESULTS
  A total of 8,018 patients were included. Uninsured patients were more likely to be male and younger, whereas the Medicare patient group had significantly fewer male patients. Rates of co-morbidities were highest in the Medicare group (28.1%) versus the private insurance (16.7%), Medicaid (19.9%), and uninsured (12.9%) groups (p < 0.05). However, among patients with any co-morbidity, there was no difference in the average number of co-morbidities between insurance groups. The rate of infection was highest in Medicaid patients (7.7%) versus private (5.6%), Medicare (6.3%), and uninsured (4.3%) patients (p < 0.05). Only Medicaid was associated with a significantly greater risk of developing a post-injury infection (odds ratio 1.6; 95% confidence interval 1.1-2.3).
  
  
  CONCLUSIONS
  The presence of insurance, namely Medicaid, does not equate to diagnosis and management of conditions that affect trauma outcomes. Medicaid is associated with worse pre-trauma health maintenance and a greater risk of infection.
authors.affiliation: 1 Department of Surgery, Alpert Medical School of Brown University , Providence, Rhode Island.
authors.forename: Jaswin S
authors.initials: JS
authors.lastname: Sawhney
authors.affiliation: 1 Department of Surgery, Alpert Medical School of Brown University , Providence, Rhode Island.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Stephen
authors.affiliation: 2 Rhode Island Hospital/Lifespan , Providence, Rhode Island.
authors.forename: Hector
authors.initials: H
authors.lastname: Nunez
authors.affiliation: 1 Department of Surgery, Alpert Medical School of Brown University , Providence, Rhode Island.
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Lueckel
authors.affiliation: 1 Department of Surgery, Alpert Medical School of Brown University , Providence, Rhode Island.
authors.forename: Tareq
authors.initials: T
authors.lastname: Kheirbek
authors.affiliation: 1 Department of Surgery, Alpert Medical School of Brown University , Providence, Rhode Island.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Adams
authors.affiliation: 1 Department of Surgery, Alpert Medical School of Brown University , Providence, Rhode Island.
authors.forename: William G
authors.initials: WG
authors.lastname: Cioffi
authors.affiliation: 1 Department of Surgery, Alpert Medical School of Brown University , Providence, Rhode Island.
authors.forename: Daithi S
authors.initials: DS
authors.lastname: Heffernan
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured; D006278:Medicare; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology*; D014481:United States; D014947:Wounds and Injuries / Q000453:epidemiology*; D055815:Young Adult