K. L. Haines1, T. Zens1, C. Warner-Hillard1, H. Jung1, S. Agarwal1 1University Of Wisconsin,Surgery,Madison, WI, USA
Introduction: To date, many studies have shown both racial and socioeconomic disparities exist with regard to outcomes in trauma. This study evaluates all trauma patients over a 3-year period to determine what factors contribute to their mortality, controlling for injury severity.
Methods: All trauma patients ≥ 15 years old from 2012 to 2015 were queried from The National Trauma Data Bank. Pearson Chi2 and multivariate logistic regression models for mortality were performed controlling for patient age, gender, co-morbidities, injury severity (ISS), insurance, race, and ethnicity.
Results: When evaluating 2,921,790 patients, uninsured patients are 2.2 times more likely to die as compared to insured patients (OR 2.2, p<0.0001). Patients with Medicare are 1.5 times more likely to die, government-insured patients were 2.0 times, Medicaid 1.2 times, and auto insurance 1.4 time more likely to die than privately insured patients (p<0.0001). African Americans (p=0.99, American Indians (p=0.86), and Hispanics p=0.26) controlling for socioeconomic status had the same mortality risk as Caucasian patients. History of bleeding disorder, current chemotherapy or disseminated cancer, diabetes, cirrhosis, respiratory disease, history of MI, peripheral vascular disease, CHF, renal failure, esophageal varices, history of CVA all significantly contributed to mortality and were controlled for in this model (p<0.05). ISS (OR 1.1), gender (OR 1.4), age (OR 1.0), and alcohol use (OR 1.2) significantly correlated with mortality in this regression (p<0.001).
Conclusion: When analyzing all trauma patients, every patient despite their injury severity, medical comorbidities, race and ethnicity was more likely to die if they did not have private or worker’s compensation insurance. Patients identified as African American, American Indian, or Hispanic had identical outcomes as Caucasian patients. Currently, mortality in trauma directly correlates with financial wellbeing.