Background
Prior studies have demonstrated that race and insurance status predict inpatient trauma
mortality, but have been limited by their inability to adjust for direct measures
of socioeconomic status (SES) and comorbidities. Our study aimed to identify whether
a relationship exists between SES and inpatient trauma mortality after adjusting for
known confounders.
Methods
Trauma patients aged 18–65 years with an Injury Severity Scores (ISS) of ≥9 were identified
using the 2003–2009 Nationwide Inpatient Sample. Median household income (MHI) by
zip code, available by quartiles, was used to measure SES. Multiple logistic regression
analyses were performed to determine odds of inpatient mortality by MHI quartile,
adjusting for ISS, type of injury, comorbidities, and patient demographics.
Results
In all, 267,621 patients met inclusion criteria. Patients in lower wealth quartiles
had significantly greater unadjusted inpatient mortality compared with the wealthiest
quartile. Adjusted odds of death were also higher compared with the wealthiest quartile
for Q1 (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.06–1.20), Q2 (OR, 1.09;
95% CI, 1.02–1.17), and Q3 (OR, 1.11; 95% CI, 1.04–1.19).
Conclusion
MHI predicts inpatient mortality after adult trauma, even after adjusting for race,
insurance status, and comorbidities. Efforts to mitigate trauma disparities should
address SES as an independent predictor of outcomes.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Leading causes of unintentional and intentional injury mortality: United States, 2000–2009.Am J Public Health. 2012; 102: e84-e92
- The impact of insurance status on actuarial survival in hospitalized trauma patients: when do they die?.J Trauma. 2011; 70: 130-134
- Race and insurance status as risk factors for trauma mortality.Arch Surg. 2008; 143: 945-949
- Insurance status is a potent predictor of outcomes in both blunt and penetrating trauma.Am J Surg. 2010; 199: 554-557
- Disparities in trauma care and outcomes in the United States: a systematic review and meta-analysis.J Trauma Acute Care Surg. 2013; 74: 1195-1205
- Socioeconomic inequalities in health. No easy solution.JAMA. 1993; 269: 3140-3145
- Social class, susceptibility and sickness.Am J Epidemiol. 1976; 104: 1-8
- Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease.Am J Public Health. 1992; 82: 816-820
- Socioeconomic status, ethnicity, and risk of coronary heart disease.Am J Epidemiol. 1980; 111: 407-414
- Economic status and survival of cancer patients.Cancer. 1977; 39: 467-477
- Mortality and economic level in an urban area.Public Health Rep. 1960; 75: 841-851
- Socioeconomic status and the occurrence of fatal and nonfatal injury in the United States.Am J Public Health. 2000; 90: 70-77
- Individual and area socioeconomic inequalities in cause-specific unintentional injury mortality: 11-year follow-up study of 2.7 million Canadians.Accid Anal Prev. 2012; 45: 99-106
Overview of the Nationwide Inpatient Sample (NIS) [updated 2003–2009]. Available from: http://www.hcup-us.ahrq.gov/nisoverview.jsp.
Stagg V. CHARLSON: Stata module to calculate Charlson index of comorbidity [updated 2006; cited 2012]. Available from: http://ideas.repec.org/c/boc/bocode/s456719.html.
- Association between hospitals caring for a disproportionately high percentage of minority trauma patients and increased mortality: a nationwide analysis of 434 hospitals.Arch Surg. 2012; 147: 63-70
- Geographic variation in health care and the problem of measuring racial disparities.Perspect Biol Med. 2005; 48: S42-S53
- Disparities in health care are driven by where minority patients seek care: examination of the hospital quality alliance measures.Arch Intern Med. 2007; 167: 1233-1239
- An overview on cognitive aspects implicated in medical decisions.Eur J Intern Med. 2011; 22: 547-553
- Perspective: Uses and misuses of thresholds in diagnostic decision making.Acad Med. 2010; 85: 556-563
- Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients.J Gen Intern Med. 2007; 22: 1231-1238
- Association of unconscious race and social class bias with vignette-based clinical assessments by medical students.JAMA. 2011; 306: 942-951
- Heuristic decision making in medicine.Dialogues Clin Neurosci. 2012; 14: 77-89
- Socioeconomic disparities in infant mortality after nonaccidental trauma: a multicenter study.J Trauma. 2010; 69: 20-25
- Racial disparities in mortality among adults hospitalized after injury.Med Care. 2008; 46: 192-199
Article info
Publication history
Accepted:
May 28,
2013
Footnotes
Financial support for this work was provided by: National Institutes of Health/NIGMS K23GM093112-01 and American College of Surgeons C. James Carrico Fellowship for the study of Trauma and Critical Care (Dr Haider).
Identification
Copyright
© 2013 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
