Does insurance status matter at a public, level I trauma center?

Ali Salim, Marcus Ottochian, Joseph DuBose, Kenji Inaba, Pedro Teixeira, Linda S Chan, Daniel R Margulies
Journal of Trauma 2010, 68 (1): 211-6

BACKGROUND: It has previously been demonstrated that a lack of insurance impedes access to health care services and may affect outcome after acute medical events. Very little data exists on the impact of insurance status on outcomes after traumatic injury. The purpose of this study was to determine whether insurance status has an impact on the outcomes of trauma patients admitted to a publicly funded county level I trauma center.

PATIENTS: This is a retrospective study of adult trauma patients (aged 18 years or older) admitted between January 1,1998, and December 31, 2005. Patients transferred out within 1 week of injury were excluded. Variables examined included demographics, insurance status, mechanism of injury, Injury Severity Score, Abbreviated Injury Scales, Glasgow Coma Scale, procedures performed, and outcomes. Logistic regression was used to determine independent risk factors for mortality.

RESULTS: Sixty-eight percent of the 29,829 patients admitted were uninsured. Uninsured patients were younger (36 versus 41, p < 0.0001) and less severely injured (Injury Severity Score 8 versus 10, p < 0.0001) but had a significantly higher mortality rate (7.0% versus 4.9%, p < 0.0001) compared with insured counterparts. Logistic regression identified uninsured status as an independent risk factor for mortality (AOR, 3.4; 95% confidence interval, 2.9-4.1; p < 0.0001). There was significant disparity between the mortality rates for uninsured and insured patients within the Black (7.1% versus 3.3%, p < 0.0001) and Hispanic (6.5% versus 4.1%, p < 0.0001) populations. No such mortality difference was observed in the white (7.2% versus 6.9%, p = 0.7) and Asian (9.7% versus 9.2%, p = 0.8) populations.

CONCLUSION: Despite being younger and less severely injured, uninsured trauma patients had a significantly higher mortality rate. The etiology of this discrepancy is unclear and warrants further investigation.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"