Insurance Coverage Is Associated with Mortality after Gunshot Trauma
| Autor: | Kristopher C. Dozier, Rita O. Kwan, Elizabeth L. Cureton, Gregory P. Victorino, Javid Sadjadi, Marvin A. Miranda |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Poison control Health Services Accessibility Insurance Coverage Injury Severity Score Injury prevention Epidemiology medicine Humans Hospital Mortality Chi-Square Distribution business.industry Mortality rate Odds ratio Middle Aged Revised Trauma Score Surgery Logistic Models Emergency medicine Female Wounds Gunshot business Chi-squared distribution |
| Zdroj: | Journal of the American College of Surgeons. 210:280-285 |
| ISSN: | 1072-7515 |
| DOI: | 10.1016/j.jamcollsurg.2009.12.002 |
| Popis: | Background Poor access to adequate health care coverage is associated with poor outcomes for many chronic medical conditions. We hypothesized that insurance coverage is also associated with mortality after gunshot trauma. Study Design The trauma records for gunshot victims and their insurance status were reviewed at our center from January 1998 to December 2007. Patient demographics (age, gender, race, and insurance coverage), injury severity, hospital care (operations and radiographic studies), and in-hospital mortality were analyzed. Results There were 2,164 gunshot trauma activations reviewed during the study period. One-quarter (n = 544) of these patients had insurance and three-quarters (n = 1,620) were uninsured. The in-hospital mortality rate was significantly higher for uninsured patients than for insured patients (9% vs 6%, p=0.02). After controlling for age, gender, race, and injury severity by logistic regression analysis, the odds ratio for death of uninsured patients was 2.2 (95% CI 1.1 to 4.5). Insured patients did not differ from uninsured patients with respect to mean Injury Severity Score ([ISS] 12.2 ± 10.7 vs 12.6 ± 12.4, p=0.56); similar percentages of patients were severely injured (ISS 16 to 24, 17% vs 15%, p=0.19) and most severely injured (ISS > 24, 15% vs 16%, p=0.68). Insured patients did not differ from uninsured patients with respect to use of radiographic imaging (53% vs 50%, p=0.15) or operative intervention (37% vs 35%, p=0.35). Conclusions Despite similar injury severity, uninsured trauma patients were more likely to die after gunshot injury than insured patients. This difference could not be attributed to demographics or hospital resource use. Insurance coverage may reflect the many social determinants of health. Improving the social determinants of health in patients affected by violent trauma may be a step toward improving outcomes after trauma. |
| Databáze: | OpenAIRE |
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