1. Insurance-and race-related disparities decrease in elderly trauma patients.
- Author
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Singer MB, Liou DZ, Clond MA, Bukur M, Mirocha J, Margulies DR, Salim A, and Ley EJ
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Female, Glasgow Coma Scale, Humans, Male, Medically Uninsured, Middle Aged, United States, Wounds, Nonpenetrating ethnology, Wounds, Nonpenetrating mortality, Young Adult, Healthcare Disparities ethnology, Insurance Coverage, Medicare, Wounds, Nonpenetrating therapy
- Abstract
Background: Little focus is on health care disparities in the elderly, a population largely covered by public insurance. We characterized insurance type and race in elderly trauma patients to determine if lack of insurance or minority status predict increased mortality., Methods: The National Trauma Data Bank (version 7.0) was queried for all adult blunt trauma patients. We divided patients into two cohorts (15-64 or ≥ 65 years) based on age for universal Medicare eligibility. Our primary outcome measure was in-hospital mortality. Multiple logistic regression was used to control for confounding variables., Results: A total of 541,471 patients met inclusion criteria. Among younger patients, the most common insurance type was private (41.0%), with 26.9% uninsured. In contrast, the most common insurance type among older patients was Medicare (64.6%), with 6.0% uninsured. Within the younger cohort, private insurance (adjusted odds ratio [AOR], 0.6; p < 0.01) and other insurance (AOR, 0.8; p < 0.01) predicted reduced mortality, while Medicare predicted similar mortality (AOR, 1.1; p = 0.18) compared with no insurance. Black race (AOR, 1.4; p < 0.01) and Hispanic ethnicity (AOR, 1.4; p < 0.01) predicted higher mortality compared with white race. Within the older cohort, no insurance predicted similar mortality as Medicare (AOR, 1.0; p = 0.43), private insurance (AOR, 1.0; p = 0.51), and other insurance (AOR, 1.0; p = 0.71). Hispanic ethnicity predicted increased mortality (AOR, 1.4; p < 0.01), while Asian race was protective (AOR, 0.7; p = 0.01) compared with white race., Conclusion: Elderly trauma patients present primarily with Medicare, while younger trauma patients are mostly privately insured; elderly patients are four times more likely to be insured. Disparities caused by lack of insurance and minority race are reduced in elderly trauma patients., Level of Evidence: Epidemiologic/prognostic study, level III.
- Published
- 2013
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