Insurance status, mortality, and hospital use among pediatric trauma patients over three decades.
BACKGROUND
We investigated the association between lack of insurance and mortality, resource use, and medical comorbidities among pediatric trauma patients.


METHODS
Our trauma database was queried for patients <18 years old from 1989 through 2013. Data collected included demographics, injury severity score (ISS), and insurance status. Dependent variables included major medical comorbidities, hospital and ICU lengths of stay (LOS), and mortality. Logistic regression and tests of equivalence were used to analyze the data.


RESULTS
A total of 3120 patients were included. The mortality among patients with insurance was 3.6% compared to 8.4% among those without insurance (p=0.0001, OR =2.42, 95% CI=1.53-3.82). This relationship remained statistically significant with adjustment via multivariable logistic regression (p=0.0001, OR =2.83, 95% CI: 1.64-4.74). Hospital and ICU LOS were significantly greater among insured patients in severely and moderately injured samples, respectively. There was no correlation between insurance and medical comorbidities. The uninsured mortality rate was 12.9% from 1989 to 1997 compared to 3.9% in 2006-2013.


CONCLUSIONS
Lack of insurance was associated with mortality but not preexisting comorbidity. This relationship persisted over time despite an overall decline in mortality. Additionally, lack of insurance was associated with decreased hospital stay and ICU utilization.


METHODS
Treatment Study, Level III.
Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, United States. Electronic address: christopher.reed2@duke.edu.
Chistopher R
CR
Reed
Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, United States. Electronic address: mehamill@carilionclinic.org.
Mark E
ME
Hamill
Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, United States. Electronic address: sdsafford@carilionclinic.org.
Shawn D
SD
Safford
D002648:Child; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014481:United States; D014947:Wounds and Injuries / Q000401:mortality*
Health disparities; Insurance; Payer status; Trauma