Background
Pedestrian trauma is the most lethal blunt trauma mechanism, and the rate of mortality
in African Americans and Hispanics is twice that compared with whites. Whether insurance
status and differential survival contribute to this disparity is unknown.
Methods
This study is a review of vehicle-struck pedestrians in the National Trauma Data Bank,
v7.0. Patients <16 years and ≥65 years, as well as patients with Injury Severity Score
(ISS) <9, were excluded. Patients were categorized as white, African American, or
Hispanic, and as privately insured, government insured, or uninsured. With white and
privately insured patients as reference, logistic regression was used to evaluate
mortality by race and insurance status after adjusting for patient and injury characteristics.
Results
In all, 26,404 patients met inclusion criteria. On logistic regression, African Americans
had 22% greater odds of mortality (odds ratio [OR], 1.22; 95% confidence interval
[CI], 1.06–1.41) and Hispanics had 33% greater odds of mortality (OR, 1.33; 95% CI,
1.14–1.54) compared with whites. Uninsured patients had 77% greater odds of mortality
(OR, 1.77; 95% CI, 1.52–2.06) compared with privately insured patients.
Conclusion
African American and Hispanic race, as well as uninsured status, increase the risk
of mortality after pedestrian crashes. Given the greater incidence of pedestrian crashes
in minorities, this compounded burden of injury mandates pedestrian trauma prevention
efforts in inner cities to decrease health disparities.
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Article info
Publication history
Accepted:
April 13,
2010
Identification
Copyright
© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
