R. A. Rauh1, T. J. Zens1, G. Leverson1, M. V. Beems1, S. K. Agarwal1 1University Of Wisconsin,Trauma And Acute Care Surgery,Madison, WI, USA
Introduction:
Healthcare disparities based on race and socioeconomic status have been documented in the literature; however, data on how these factors effect outcomes in patients experiencing severe thoracic trauma is lacking. This study aims to identify potential disparities in treatment and outcomes in this patient population.
Methods:
The National Trauma Data Bank was queried for all rib fracture patients with ISS scores>15 between 2007-2012. A univariate and multivarite logistic regression model was run which controlled for patient co-morbidities, age, ISS, and associated injuries. Patient outcomes in length of stay, mortality, discharge disposition, and in hospital procedures were compared between patients of varying race and insurance status to white and privately insured patients, respectively.
Results:
A cohort of 69,424 patients were selected for analysis. 87.1% of patients were white, 10.2% African American and 1.98% Asian. 14.2% of patients were covered by private insurance vs. 30.1% by Medicare and 21.5% by Medicaid. 34.1% were uninsured. Uninsured (OR = 1.753; CI = 1.468- 2.094), Medicaid (OR = 1.568; CI = 1.295-1.898), and Medicare (OR = 2.768; CI = 2.313-3.313) patients had higher in-hospital mortality than privately insured patients. Uninsured patients (OR = 0.804; CI = 0.745, 0.867) were less likely to exceed the median hospital stay, while Medicaid (OR = 1.445 CI = 1.331-1.568) and African American patients (OR = 1.144, CI= 1.083-1.208) were more likely exceed the median hospital stay than those privately insured. Medicare (OR = 1.103; CI = 1.004-1.212) and Medicaid (OR = 1.328; CI =1.210-1.458) patients were more likely to receive an epidural during the course of care than privately insured patients, but there were no other statistically significant differences with regards to race or insurance status. Medicaid (OR=1.330; CI = 1.216-1.453) and African American patients (OR = 1.081; CI= 1.018-1.148) were more likely to require mechanical ventilation than privately insured or White patients. Finally, uninsured patients (OR=0.572; CI = 0.505-0648) were less likely to receive continuing medical care after hospitalization in a nursing facility or acute care rehab center. In contrast, Medicaid (OR=1.412; CI = 1.249-1.595) and Medicare (OR = 3.661; CI = 3.252- 4.121) patients were more likely to be discharged one of these facilities.
Conclusion:
When examining healthcare disparities among thoracic trauma patients, we documented less significant differences among racial groups than among insurance statuses. Overall, we found the uninsured were more likely to be discharged early to their homes while Medicare and Medicaid patients were more likely to be discharged to a care facilities such as nursing homes or acute care hospitals. We also found the privately insured had lower mortality than Medicare, Uninsured and Medicare patients. Further research is needed on whether changes implemented by Affordable Care Act have helped to eliminate this disparities.