@article{ref1,
title="Race and insurance status are associated with different management strategies after thoracic trauma",
journal="Journal of surgical research",
year="2021",
author="Klein, Michael and Krowsoski, Leandra and Bukur, Marko and Frangos, Spiros and Tandon, Manish and Berry, Cherisse and DiMaggio, Charles and Velez-Rosborough, Anna and Rebollo Salazar, Daniela",
volume="261",
number="",
pages="18-25",
abstract="INTRODUCTION: Health-care disparities based on race and socioeconomic status among trauma patients are well-documented. However, the influence of these factors on the  management of rib fractures following thoracic trauma is unknown. The aim of this  study is to describe the association of race and insurance status on management and  outcomes in patients who sustain rib fractures. <br><br>METHODS: The Trauma Quality  Improvement Program database was used to identify adult patients who presented with  rib fractures between 2015 and 2016. Patient demographics, injury severity,  procedures performed, and outcomes were evaluated. Multivariate logistic regression  analysis was used to determine the effect of race and insurance status on mortality  and the likelihood of rib fixation surgery and epidural analgesia for pain  management. <br><br>RESULTS: A total of 95,227 patients were identified. Of these, 2923  (3.1%) underwent rib fixation. Compared to White patients, Asians (AOR: 0.57,  P = 0.001), Blacks or African-Americans (AA) (AOR: 0.70, P < 0.001), and  Hispanics/Latinos (HL) (AOR: 0.78, P < 0.001) were less likely to undergo rib  fixation surgery. AA patients (AOR: 0.67, P = 0.004), other non-Whites (ONW) (AOR:  0.61, P = 0.001), and HL (AOR 0.65, P = 0.006) were less likely to receive epidural  analgesia. Compared to privately insured patients, mortality was higher in uninsured  patients (AOR: 1.72, P < 0.001), Medicare patients (AOR: 1.80, P < 0.001), and  patients with other non-private insurance (AOR: 1.23, P < 0.001). <br><br>CONCLUSIONS:  Non-White race is associated with a decreased likelihood of rib fixation and/or  epidural placement, while underinsurance is associated with higher mortality in  patients with thoracic trauma. Prospective efforts to examine the socioeconomic  disparities within this population are warranted.<p /> <p>Language: en</p>",
language="en",
issn="0022-4804",
doi="10.1016/j.jss.2020.11.026",
url="http://dx.doi.org/10.1016/j.jss.2020.11.026"
}