The severity of disparity: Increasing injury intensity accentuates disparate outcomes following trauma

Authors

Lia I. Losonczy, Johns Hopkins University School of Medicine, Baltimore, MD, US
Cassandra V. Villegas, University of Arizona
P Logan Weygandt, Johns Hopkins University School of Medicine, Baltimore, MD, US
Erin C. Hall, Johns Hopkins University School of Medicine, Baltimore, MD, US
Eric B. Schneider, Johns Hopkins University School of Medicine, Baltimore, MD, US
Lisa A. Cooper, Johns Hopkins University School of Medicine, US
Edward E. Cornwell, Howard University College of Medicine, Washington, D.C. US
Elliott R. Haut, Johns Hopkins University School of Medicine, Baltimore, MD, US
David T. Efron, Johns Hopkins University School of Medicine, Baltimore, MD, US
Adil H. Haider, Johns Hopkins University School of Medicine, Baltimore, MD, USFollow

Document Type

Article

Department

General Surgery

Abstract

Objective: Studies have shown disparities in mortality among racial groups and among those with differing insurance coverage. Our goal was to determine if injury severity affects these disparities.
Methods: We classified patients from the 2003-2008 National Trauma Data Banks suffering moderate to severe injuries into six groups based on race/ethnicity and insurance, stratifying by injury severity. Logistic regression compared odds of death between races-ethnicities/insurance groups within these strata. We adjusted for age, gender, Injury Severity Score, Glasgow Coma Scale motor component, hypotension, and mechanism of injury.
Results: Patients meeting inclusion criteria numbered 760,598. Disparities between races-ethnicities/insurance groups increased as injury severity worsened. Odds of death for uninsured Black patients compared with insured Whites increased from 1.82 among moderately injured patients to 3.14 among severely injured, hypotensive patients. A similar pattern was seen among uninsured Hispanic patients.
Conclusions: Disparities in trauma mortality suffered by minority and uninsured patients, when compared with non-minority and insured patients, worsen with increasing injury.

Comments

This work was published before the author joined Aga Khan University

Publication (Name of Journal)

Journal of health care for the poor and underserved

Recommended Citation

Losonczy, L. I., Villegas, C. V., Weygandt, P. L., Hall, E. C., Schneider, E. B., Cooper, L. A., Cornwell, E. E., Haut, E. R., Efron, D. T., Haider, A. H. (2014). The severity of disparity: Increasing injury intensity accentuates disparate outcomes following trauma. Journal of health care for the poor and underserved, 25(1), 308-320.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_gen/242