title: No Disparity for American Indians in Surgery for Pelvis/Lower Extremity Fractures: a Cohort Study of the National Trauma Data Bank (NTDB).
abstract: Racial/ethnic disparities in trauma care have been reported. The American Indian/Alaska Native (AI/AN) population faces a twofold to fourfold increase of risk for traumatic injury. We hypothesized that surgical intervention and time to surgery were associated with race/ethnicity, specifically AI/AN compared to other race/ethnicity groups with open pelvic and lower extremity fractures (OPLEFx).
  
  
  
  Non-AI/AN racial/ethnic groups were compared to AI/ANs among adults aged 15 years and older using the National Trauma Data Bank for 2008-2012. OPLEFx were identified via ICD-9-CM. Predictors of surgery and time to surgery were modeled via logistic regression and survival analyses.
  
  
  
  AI/AN patients (2.7 %, n = 206) were younger (36 ± 16 versus 41 ± 18 years, p < 0.001) and more likely to have Medicaid and other government insurance. There were no differences in AI/ANs versus non-AI/ANs undergoing surgery (88.4 versus 86.8 %, respectively) or time to surgery (11.7 ± 25.3 versus 12.0 ± 22.5 h, respectively). Injury severity was predictive of surgery in all six models (OR = 0.04 to 0.32). A race-gender interaction increased odds of surgery in the AI/AN versus all other races model (OR = 3.58, 95 % CI 1.18-10.84) and in three of five pairwise models. Median time to surgery varied by race, favoring AI/ANs with least preoperative time.
  
  
  
  The AI/AN population experienced no disparities in rate of, or time to, OPLEFx surgery. Race-specific predictors for surgery included gender, probability of death, and multiple fractures. More study is warranted to ameliorate trauma care disparities and achieve reasonably equitable care as demonstrated in AI/ANs with OPLEFx.
authors.affiliation: Trauma Program, Chandler Regional Medical Center, 485 South Dobson Rd, Suite 201, Chandler, AZ, 85224, USA. alan.cook@dignityhealth.org.
authors.forename: Alan
authors.identifier: 0000-0003-0301-3125
authors.initials: A
authors.lastname: Cook
authors.affiliation: Trauma Program, Chandler Regional Medical Center, 485 South Dobson Rd, Suite 201, Chandler, AZ, 85224, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Chapple
authors.affiliation: Orthopedic Trauma Program, Chandler Regional Medical Center, 485 South Dobson Rd, Suite 201, Chandler, AZ, 85224, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Motzkin
authors.affiliation: Trauma Program, Chandler Regional Medical Center, 485 South Dobson Rd, Suite 201, Chandler, AZ, 85224, USA.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Ward
authors.affiliation: Trauma Program, Chandler Regional Medical Center, 485 South Dobson Rd, Suite 201, Chandler, AZ, 85224, USA.
authors.forename: Forrest
authors.initials: F
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D050723:Fractures, Bone / Q000208:ethnology* / Q000601:surgery; D054624:Health Status Disparities; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: American Indians/Alaska Natives; Healthcare disparities; Injury; Orthopedic surgery; Race/ethnicity; Trauma