The Association of Race, Socioeconomic Status, and Insurance on Trauma Mortality

Judy N. Mikhail, Lynne S. Nemeth, Martina Mueller, Charlene Pope, Elizabeth G. NeSmith, Kenneth L. Wilson, Michael McCann, Samir M. Fakhry

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Although race, socioeconomic status, and insurance individually are associated with trauma mortality, their complex interactions remain ill defined. Methods: This retrospective cross-sectional study from a single Level I center in a racially diverse community was linked by socioeconomic status, insurance, and race from 2000 to 2009 for trauma patients aged 18-64 years with an injury severity score more than 9. The outcome measure was inpatient mortality. Multiple logistic regression analyses were performed to investigate confounding variables known to predict trauma mortality. Results: A total of 4,007 patients met inclusion criteria. Individually, race, socioeconomic status, and insurance were associated with increased mortality rate; however, in multivariate analysis, only insurance remained statistically significant and varied by insurance type with age. Odds of death were higher for Medicare (odds ratio [OR] = 3.63, p =.006) and other insurance (OR = 3.02, p =.007) than for Private Insurance. However, when grouped into ages 18-40 years versus 41-64 years, the insurance influences changed with Uninsured and Other insurance (driven by Tricare) predicting mortality in the younger age group, while Medicare remained predictive in the older age group. Conclusions: Insurance type, not race or socioeconomic status, is associated with trauma mortality and varies with age. Both Uninsured and Tricare insurance were associated with mortality in younger age trauma patients, whereas Medicare was associated with mortality in older age trauma patients. The lethality of the Tricare group warrants further investigation.

Original languageEnglish (US)
Pages (from-to)347-356
Number of pages10
JournalJournal of Trauma Nursing
Volume23
Issue number6
DOIs
StatePublished - Dec 1 2016

Fingerprint

Insurance
Social Class
Mortality
Wounds and Injuries
Medicare
Age Groups
Odds Ratio
Injury Severity Score
Confounding Factors (Epidemiology)
Inpatients
Multivariate Analysis
Cross-Sectional Studies
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)

Keywords

  • Health care disparities
  • Insurance type
  • Race
  • Socioeconomic status
  • Trauma mortality

ASJC Scopus subject areas

  • Emergency
  • Critical Care
  • Advanced and Specialized Nursing

Cite this

Mikhail, J. N., Nemeth, L. S., Mueller, M., Pope, C., NeSmith, E. G., Wilson, K. L., ... Fakhry, S. M. (2016). The Association of Race, Socioeconomic Status, and Insurance on Trauma Mortality. Journal of Trauma Nursing, 23(6), 347-356. https://doi.org/10.1097/JTN.0000000000000246

The Association of Race, Socioeconomic Status, and Insurance on Trauma Mortality. / Mikhail, Judy N.; Nemeth, Lynne S.; Mueller, Martina; Pope, Charlene; NeSmith, Elizabeth G.; Wilson, Kenneth L.; McCann, Michael; Fakhry, Samir M.

In: Journal of Trauma Nursing, Vol. 23, No. 6, 01.12.2016, p. 347-356.

Research output: Contribution to journalArticle

Mikhail, JN, Nemeth, LS, Mueller, M, Pope, C, NeSmith, EG, Wilson, KL, McCann, M & Fakhry, SM 2016, 'The Association of Race, Socioeconomic Status, and Insurance on Trauma Mortality', Journal of Trauma Nursing, vol. 23, no. 6, pp. 347-356. https://doi.org/10.1097/JTN.0000000000000246
Mikhail, Judy N. ; Nemeth, Lynne S. ; Mueller, Martina ; Pope, Charlene ; NeSmith, Elizabeth G. ; Wilson, Kenneth L. ; McCann, Michael ; Fakhry, Samir M. / The Association of Race, Socioeconomic Status, and Insurance on Trauma Mortality. In: Journal of Trauma Nursing. 2016 ; Vol. 23, No. 6. pp. 347-356.
@article{fb7e7da7fa8c41c596228ca48e3ba2da,
title = "The Association of Race, Socioeconomic Status, and Insurance on Trauma Mortality",
abstract = "Background: Although race, socioeconomic status, and insurance individually are associated with trauma mortality, their complex interactions remain ill defined. Methods: This retrospective cross-sectional study from a single Level I center in a racially diverse community was linked by socioeconomic status, insurance, and race from 2000 to 2009 for trauma patients aged 18-64 years with an injury severity score more than 9. The outcome measure was inpatient mortality. Multiple logistic regression analyses were performed to investigate confounding variables known to predict trauma mortality. Results: A total of 4,007 patients met inclusion criteria. Individually, race, socioeconomic status, and insurance were associated with increased mortality rate; however, in multivariate analysis, only insurance remained statistically significant and varied by insurance type with age. Odds of death were higher for Medicare (odds ratio [OR] = 3.63, p =.006) and other insurance (OR = 3.02, p =.007) than for Private Insurance. However, when grouped into ages 18-40 years versus 41-64 years, the insurance influences changed with Uninsured and Other insurance (driven by Tricare) predicting mortality in the younger age group, while Medicare remained predictive in the older age group. Conclusions: Insurance type, not race or socioeconomic status, is associated with trauma mortality and varies with age. Both Uninsured and Tricare insurance were associated with mortality in younger age trauma patients, whereas Medicare was associated with mortality in older age trauma patients. The lethality of the Tricare group warrants further investigation.",
keywords = "Health care disparities, Insurance type, Race, Socioeconomic status, Trauma mortality",
author = "Mikhail, {Judy N.} and Nemeth, {Lynne S.} and Martina Mueller and Charlene Pope and NeSmith, {Elizabeth G.} and Wilson, {Kenneth L.} and Michael McCann and Fakhry, {Samir M.}",
year = "2016",
month = "12",
day = "1",
doi = "10.1097/JTN.0000000000000246",
language = "English (US)",
volume = "23",
pages = "347--356",
journal = "Journal of trauma nursing : the official journal of the Society of Trauma Nurses",
issn = "1078-7496",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - The Association of Race, Socioeconomic Status, and Insurance on Trauma Mortality

AU - Mikhail, Judy N.

AU - Nemeth, Lynne S.

AU - Mueller, Martina

AU - Pope, Charlene

AU - NeSmith, Elizabeth G.

AU - Wilson, Kenneth L.

AU - McCann, Michael

AU - Fakhry, Samir M.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background: Although race, socioeconomic status, and insurance individually are associated with trauma mortality, their complex interactions remain ill defined. Methods: This retrospective cross-sectional study from a single Level I center in a racially diverse community was linked by socioeconomic status, insurance, and race from 2000 to 2009 for trauma patients aged 18-64 years with an injury severity score more than 9. The outcome measure was inpatient mortality. Multiple logistic regression analyses were performed to investigate confounding variables known to predict trauma mortality. Results: A total of 4,007 patients met inclusion criteria. Individually, race, socioeconomic status, and insurance were associated with increased mortality rate; however, in multivariate analysis, only insurance remained statistically significant and varied by insurance type with age. Odds of death were higher for Medicare (odds ratio [OR] = 3.63, p =.006) and other insurance (OR = 3.02, p =.007) than for Private Insurance. However, when grouped into ages 18-40 years versus 41-64 years, the insurance influences changed with Uninsured and Other insurance (driven by Tricare) predicting mortality in the younger age group, while Medicare remained predictive in the older age group. Conclusions: Insurance type, not race or socioeconomic status, is associated with trauma mortality and varies with age. Both Uninsured and Tricare insurance were associated with mortality in younger age trauma patients, whereas Medicare was associated with mortality in older age trauma patients. The lethality of the Tricare group warrants further investigation.

AB - Background: Although race, socioeconomic status, and insurance individually are associated with trauma mortality, their complex interactions remain ill defined. Methods: This retrospective cross-sectional study from a single Level I center in a racially diverse community was linked by socioeconomic status, insurance, and race from 2000 to 2009 for trauma patients aged 18-64 years with an injury severity score more than 9. The outcome measure was inpatient mortality. Multiple logistic regression analyses were performed to investigate confounding variables known to predict trauma mortality. Results: A total of 4,007 patients met inclusion criteria. Individually, race, socioeconomic status, and insurance were associated with increased mortality rate; however, in multivariate analysis, only insurance remained statistically significant and varied by insurance type with age. Odds of death were higher for Medicare (odds ratio [OR] = 3.63, p =.006) and other insurance (OR = 3.02, p =.007) than for Private Insurance. However, when grouped into ages 18-40 years versus 41-64 years, the insurance influences changed with Uninsured and Other insurance (driven by Tricare) predicting mortality in the younger age group, while Medicare remained predictive in the older age group. Conclusions: Insurance type, not race or socioeconomic status, is associated with trauma mortality and varies with age. Both Uninsured and Tricare insurance were associated with mortality in younger age trauma patients, whereas Medicare was associated with mortality in older age trauma patients. The lethality of the Tricare group warrants further investigation.

KW - Health care disparities

KW - Insurance type

KW - Race

KW - Socioeconomic status

KW - Trauma mortality

UR - http://www.scopus.com/inward/record.url?scp=84997818347&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84997818347&partnerID=8YFLogxK

U2 - 10.1097/JTN.0000000000000246

DO - 10.1097/JTN.0000000000000246

M3 - Article

C2 - 27828890

AN - SCOPUS:84997818347

VL - 23

SP - 347

EP - 356

JO - Journal of trauma nursing : the official journal of the Society of Trauma Nurses

JF - Journal of trauma nursing : the official journal of the Society of Trauma Nurses

SN - 1078-7496

IS - 6

ER -