B. Lilley1,2, J. Proaño-Zamudio1, D. Argandykov1, A. Renne1, E. Lagazzi1, M. Abiad1, W. Rafaqat1, L. Onyewadume3, C. N. Paranjape1, J. O. Hwabejire1 1Massachusetts General Hospital, Trauma, Emergency Surgery, And Surgical Critical Care, Boston, MA, USA 2Frank H. Netter MD School of Medicine – Quinnipiac University, North Haven, CONNECTICUT, USA 3Harvard School Of Public Health, Boston, MA, USA
Introduction: Racial minority groups have a higher risk of being injured by firearms compared to White Americans, but differences in outcomes after medical treatment remain poorly studied. This study aims to examine the association of race, ethnicity, and insurance type with outcomes after gunshot injury.
Methods: The TQIP 2017 dataset was queried. We included patients with gunshot wounds (GSW) who were transported by ground to a Level I or Level II trauma center. Patients with severe head injury were excluded. The primary outcomes were mortality and discharge disposition. Descriptive statistics and multivariable logistic regression were used to explore the association of race, ethnicity, and insurance type with treatment outcomes.
Results: A total of 2,544 GSW patients were included. 712 (28.0%) were white, 1,472 (57.9%) were black or African-American. 2,092 (82.2%) were Hispanic or latino, most patients (41.9%) were insured by Medicare or Medicaid. Overall, 386 (17.9%) patients died in-hospital. From the survivors, 1,558 (72.2%) were discharge to home and 302 (14.0%) to post-acute care (PAC). Independent predictors of mortality included government insurance (compared to private, odds-ratio [OR]=1.72, 95% confidence interval[CI]: 1.11-2.68, p=0.016) or self-pay (OR=3.09, 95%CI: 1.99-4.78, p<0.001), and treatment at a level II trauma-center (OR=1.47, 95%CI: 1.07-2.06, p=0.017). Self-pay was associated with decreased odds of discharge to PAC (OR=0.43, 95%CI: 0.28-0.67, p<0.001). Black patients were less likely to be privately insured (18.3% vs 27.5%, p<0.001) and more likely to be insured by Medicaid compared to white patients (31.2% vs 35.7%, p=0.021).
Conclusion: In patients with gunshot injuries treated at accredited trauma centers, insurance appears to be a socioeconomic driver of disparities in outcomes. Differences in insurance coverage appear to be related to race, which may translate deeply rooted socioeconomic inequalities. Recognition of these inequalities is key to improve outcome in those most vulnerable to gunshot injury.