Insurance type is a determinant of 2-year mortality after non-neurologic trauma
| Autor: | Louis J. Magnotti, Martin A. Croce, Ben L. Zarzaur, Brad Ryan Stair, Timothy C. Fabian |
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| Rok vydání: | 2009 |
| Předmět: |
Gerontology
Adult Male Pediatrics medicine.medical_specialty Adolescent United States Social Security Administration Logistic regression Medicare Wounds Nonpenetrating Article Young Adult Blunt Risk Factors Outcome Assessment Health Care Medicine Humans Young adult Socioeconomic status Aged Univariate analysis Medically Uninsured Insurance Health business.industry Medicaid Trauma center Middle Aged United States Logistic Models Social Class Master file Surgery Female business |
| Zdroj: | The Journal of surgical research. 160(2) |
| ISSN: | 1095-8673 |
| Popis: | Lack of health insurance (NO-INS) is associated with increased long-term mortality after head and spinal cord injuries (NEURO-TRA). Less is known about the influence of insurance type and long-term mortality following non-NEURO-TRA. We hypothesized that NO-INS would be associated with 2-y mortality after moderate to severe injury.Adults (or=18) treated at a level-I trauma center following a moderate to severe blunt injury (ISS15) and without NEURO-TRA from 2000-2005 and discharged alive were eligible for the study. Two-y mortality was determined utilizing the Social Security Administration Death Master File. Logistic regression analysis was used to determine if type of insurance [NO-INS, Private (PRIV-INS), Medicare/Medicaid; GOV-INS), or Other (OTH-INS)] was related to 2-y mortality.One thousand nine hundred fifty-eight patients met study inclusion/exclusion criteria. Two-y risk of death was 2.96%. On univariate analysis, admission age, lactate, and insurance type were associated with 2-y mortality (P0.25). However, race was not. After adjusting for admission age and lactate, compared with PRIV-INS, having either NO-INS or GOV-INS was significantly associated with increased 2-y mortality. The analysis was repeated without patients eligible for Medicare (Ageor=65), and GOV-INS was still associated with increased 2-y mortality (OR 4.47 P0.05).Following moderate to severe blunt, non-NEURO-TRA, having GOVT-INS or NO-INS was associated with increased 2-y mortality. The mechanism by which this association may be explained is unclear. Future research focused on elucidating mechanisms behind poor long-term outcomes should include an examination of socioeconomic status as a potential contributor to reduced long-term mortality after injury. |
| Databáze: | OpenAIRE |
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