H. Chen2, K. Haines1, T. Zens1, B. Brummeyer2, S. Agarwal1, J. E. Scarborough1 1University Of Wisconsin School Of Medicine And Public Health,Department Of Surgery, Division Of Trauma And Acute Care Surgery,Madison, WI, USA 2University Of Wisconsin,School Of Medicine And Public Health,Madison, WI, USA
Introduction:
Race and insurance status have been shown to predict outcomes in pediatric bicycle traumas. It is unknown how these factors influence outcomes in adult bicycle traumas. This study aims to evaluate the association, if any, between race and insurance status with mortality in adults.
Methods:
This retrospective cohort study used the National Trauma Data Bank (NTDB) Research Data Set for the years 2013-2015. Multivariate logistic regression models were used to determine the independent association between patient race and insurance status on helmet use and on outcomes after hospitalization for bicycle-related injury. These models adjusted for demographic factors and comorbid variables. When examining the association between race and insurance status with outcomes after hospitalization, injury characteristics were also included.
Results:
A study population of 45,063 met the inclusion and exclusion criteria. Multivariate regression demonstrated that black adults and Hispanic adults were significantly less likely to be helmeted at the time of injury than white adults [adjusted odds ratio of helmet use for blacks 0.25 (95% CI 0.22-0.28) and for Hispanics 0.33 (95% CI 0.30-0.36) versus whites]. Helmet usage was also independently associated with insurance status, with Medicare-insured patients [AOR 0.51 (95% CI 0.47-0.56) versus Private-insured patients], Medicaid-insured patients [AOR 0.18 (95% CI 0.17-0.20)], and Uninsured patients [AOR 0.29 (95% CI 0.27-0.32)] being significantly less likely to be wearing a helmet at the time of injury compared to Private-insured patients. Although patient race was not independently associated with hospital mortality among adult bicyclists, we found that Uninsured patients had significantly higher odds of mortality [AOR 2.02 (AOR 1.31-3.12] compared to Private-insured patients.
Conclusion:
Minorities and under-insured patients are significantly less likely to be helmeted at the time of bicycle-related trauma when compared to white patients and those with private insurance. Public health efforts to improve the utilization of helmets during bicycling should target these subpopulations.