Insurance status and traumatized patients' outcomes: a report from the national trauma registry of Iran.

Autor: Isazadehfar K; Social Determinants of Health Research Center (SDH), Medical Faculty, Ardabil University of Medical Sciences, Ardabil, Iran., Salamati P; Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran., Zafarghandi MR; Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran., Rahimi-Movaghar V; Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran., Khormali M; Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran., Baigi V; Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. v-baigi@sina.tums.ac.ir.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2023 Apr 24; Vol. 23 (1), pp. 392. Date of Electronic Publication: 2023 Apr 24.
DOI: 10.1186/s12913-023-09369-9
Abstrakt: Background: Trauma care is one of the most expensive medical procedures that is significantly affected by factors like insurance status. Providing medical care to injured patients has a significant impact on patients' prognosis. This study examined whether insurance status was associated with different outcomes, including hospital length of stay (HLOS), mortality, and Intensive Care Unit (ICU) admission.
Methods: This prospective study analyzed the data of traumatized patients who had been registered in the National Trauma Registry of Iran (NTRI), and hospitalized at Sina Hospital, Tehran, Iran, from March 22, 2016, to February 8, 2021. Given the type of insurance, the insured patients were classified as basic, road traffic, and foreign nationality. The outcomes of in-hospital death, ICU admission, and HLOS between insured and uninsured patients, and then different insurance statuses, were compared using regression models.
Result: A total of 5014 patients were included in the study. 49% of patients (n = 2458) had road traffic insurance, 35.2% (n = 1766) basic insurance, 10.5% (n = 528) were uninsured, and 5.2% (n = 262) had foreign nationality insurance. The mean age of patients with basic, road traffic insurance, foreign nationality, and uninsured patients was 45.2 (SD = 22.3), 37.8 (SD = 15.8), 27.8 (SD = 13.3), and 32.4 (SD = 11.9) years, respectively. There was a statistically significant association between insurance status and mean age. Based on these results, the mean age of patients with basic insurance was higher than other groups (p < 0.001). Additionally, 85.6% of the patients were male, with male to female ratio of 9.64 in road traffic insurance, 2.99 in basic insurance, 14.4 in foreign nationality, and 16 in uninsured patients. There was no statistically significant difference between in-hospital mortality in insured and uninsured patients, 98 (2.3%) vs. 12 (2.3%), respectively. The odds of in-hospital mortality in uninsured patients were 1.04 times the odds of in-hospital death in insured patients [Crude OR: 1.04, 95%CI: 0.58 to 1.90]. Multiple logistic regression showed that after adjusting for age, sex, ISS, and Cause of trauma, the odds of in-hospital death in uninsured patients were 2.97 times the odds of in-hospital death in insured patients [adjusted OR: 2.97, 95%CI: 1.43 to 6.21].
Conclusion: This study shows that having insurance can change the ICU admission, death, and HLOS in traumatized patients. The results of this study can provide essential data for national health policy for minimizing the disparities among different insurance statuses and proper use of medical resources.
(© 2023. The Author(s).)
Databáze: MEDLINE
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