Disparities in mortality after blunt injury: Does insurance type matter?

Authors

Paul Logan Weygandt, Johns Hopkins Center for Surgery Trials and Outcomes Research, Baltimore
Lia I. Losonczy, Johns Hopkins Center for Surgery Trials and Outcomes Research, Baltimore
Eric B. Schneider, Johns Hopkins Center for Surgery Trials and Outcomes Research, Baltimore
Mehreen T. Kisat, Johns Hopkins Center for Surgery Trials and Outcomes Research, Baltimore
Lauren K. Licatino, University of Arkansas for Medical Sciences, Little Rock
Edward E. Cornwell, Howard University College of Medicine, Washington
Elliot R. Haut, Johns Hopkins University School of Medicine, Baltimore
David T. Efron, Johns Hopkins Center for Surgery Trials and Outcomes Research, Baltimore
Adil H. Haider, Johns Hopkins Center for Surgery Trials and Outcomes Research, BaltimoreFollow

Document Type

Article

Department

General Surgery

Abstract

Background: Insurance-related outcomes disparities are well-known, but associations between distinct insurance types and trauma outcomes remain unclear. Prior studies have generally merged various insurance types into broad groups. The purpose of this study is to determine the association of specific insurance types with mortality after blunt injury.
Materials and methods: Cases of blunt injury among adults aged 18-64 y with an injury severity score >9 were identified using the 2007-2009 National Trauma Data Bank. Crude mortality was calculated for 10 insurance types. Multivariable logistic regression was employed to determine difference in odds of death between insurance types, controlling for injury severity score, Glasgow Coma Scale motor, mechanism of injury, sex, race, and hypotension. Clustering was used to account for possible inter-facility variations.
Results: A total of 312,312 cases met inclusion criteria. Crude mortality ranged from 3.2 to 6.0% by insurance type. Private Insurance, Blue Cross Blue Shield, Workers Compensation, and Medicaid yielded the lowest relative odds of death, while Not Billed and Self Pay yielded the highest. Compared with Private Insurance, odds of death were higher for No Fault (OR 1.25, P = 0.022), Not Billed (OR 1.77, P < 0.001), and Self Pay (OR 1.77, P < 0.001). Odds of death were higher for Medicare (OR 1.52, P < 0.001) and Other Government (OR 1.35, P = 0.049), while odds of death were lower for Medicaid (OR 0.89, P = 0.015).
Conclusions: Significant differences in mortality after blunt injury were seen between insurance types, even among those commonly grouped in other studies. Policymakers may use this information to implement programs to monitor and reduce insurance-related disparities.

Comments

This work was published before the author joined Aga Khan University

Publication (Name of Journal)

Journal of Surgical Research

Recommended Citation

Weygandt, P. L., Losonczy, L. I., Schneider, E. B., Kisat, M. T., Licatino, L. K., Cornwell, E. E., Haut, E. R., Efron, D. T., Haider, A. H. (2012). Disparities in mortality after blunt injury: Does insurance type matter?. Journal of Surgical Research, 177(2), 288-294.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_gen/240