Citation

Joseph B, Kulvatunyou N, Friese RS, Rhee P, O'Keeffe T, Branco BC, Mobily M, Wynne JL, Tang AL. Panam. J. Trauma Crit. Care Emerg. Surg. 2019; 8(2): 91-95.

Copyright

(Copyright © 2019, Panamerican Trauma Society, Publisher Jaypee Brothers Medical Publishers)

DOI

10.5005/jp-journals-10030-1245

PMID

unavailable

Abstract

BACKGROUND: Previous studies have demonstrated an association between lack of insurance and outcomes after trauma. However, it is not clear if this is merely a surrogate for socioeconomic status. The purpose of this study is to investigate the relationship between household income and mortality among injured patients.

METHODS: The Arizona Inpatient State Database was used to identify all trauma patients over a representative 1-year period. Demographics, clinical data, and outcomes were extracted. Median household income (MHI) for patients' domiciliary zip code was extracted. Patients were divided into four quartiles according to MHI (lowest, low, high, and highest). The standard statistical analysis was used to compare groups.

RESULTS: A total of 58,743 were available for analysis (lowest: 27.6%; low: 25.9%; high: 26.3%; and highest: 20.2%). There was a decrease in the proportion of males as MHI increased (lowest: 53.4%, low: 48.8%, high: 49.2%, and highest: 48.7%, p <0.001). Similarly, there was a decrease in the proportion of Hispanics and Native Americans (Hispanics: lowest: 23.6%, low: 14.9%, high: 12.9%, and highest: 5.9%, p <0.001; Native Americans: lowest: 10.8%, low: 2.5%, high: 2.9%, and highest: 0.8%, p <0.001). There was also a decrease in the incidence of penetrating trauma as MHI increased (lowest: 9.6%, low: 8.4%, high: 7.6%, and highest: 6.6%, p <0.001), in particular for gunshot wound (GSWs) (lowest: 5.7%, low: 5.4%, high: 5.0%, highest: 4.5%, p <0.001). After adjustment for demographics and clinical data, when outcomes were analyzed, there was a stepwise decrease in mortality as MHI increased (Log rank = 0.002).

CONCLUSION: Patients with low MHI have a higher adjusted mortality rate after trauma. To address health-related disparities, socioeconomic disparities must be ameliorated. Further evaluation of these results is warranted.

Language: en