Abstract
Background
Although inequities in trauma care are reported widely, some groups have theorized
that universal health insurance would decrease disparities in care for disadvantaged
minorities after a traumatic injury. We sought to examine the presence of racial disparities
in outcomes and healthcare utilization at 30- and 90-days after discharge in this
universally insured, racially diverse, American population treated for traumatic injuries.
Methods
This work studied adult beneficiaries of TRICARE treated at both military and civilian
trauma centers 2006–2014. We included patients with an inpatient trauma encounter
based on International Classification of Diseases, 9th revision (ICD-9) code. The
mechanism and severity of injury, medical comorbidities, region and environment of
care, and demographic factors were used as covariates. Race was considered the main
predictor variable with Black patients compared to Whites. Logistic regression models
were employed to assess for risk-adjusted differences in 30- and 90-day outcomes between
Blacks and Whites.
Results
A total of 87,112 patients met the inclusion criteria. Traditionally encountered disparities
for Black patients after trauma, including increased rates of mortality, were absent.
We found a statistically significant decrease in the odds of 90-day complications
for Blacks (OR 0.91; 95% CI 0.84–0.98; P = 0.01). Blacks also had lesser odds of readmission at 30-days (OR 0.87; 95% CI 0.79–0.94;
P = 0.002) and 90-days (OR 0.86; 95% CI 0.79–0.93; P < 0.001).
Conclusion
Our findings support the idea that in a universally insured, equal access system,
historic disparities for racial and ethnic minorities, including increased postinjury
morbidity, hospital readmission, and postdischarge healthcare utilization, are decreased
or even eliminated.
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Article info
Publication history
Published online: December 05, 2017
Accepted:
September 13,
2017
Footnotes
Funded in part by the Henry M. Jackson Foundation for the Advancement of Military Medicine of the Department of Defense (DoD). The following authors receive partial salary support from this grant: MAC, AJS, DJS, MS, TK, and AHH. The Henry Jackson Foundation was not involved in the design and administration of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The DoD was not involved in the design, analyses, or interpretation of results. The findings and views expressed here are those of the authors and should not be viewed as representative of the DoD or the United States Government.
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