Online Program

Insurance type and racial and ethnic disparities in ED mortality among trauma patients in Massachusetts (2008-2010)

Wednesday, November 6, 2013 : 12:45 p.m. - 1:00 p.m.

Wenjun Li, PhD, Health Statistics and Geography Lab, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA
Sylvia Hobbs, MPH, Center for Health Information and Analysis, Boston, MA
Holly Hackman, MD, MPH, Massachusetts Department of Public Health, Boston, MA
Turner Osler, MD, MS, Department of Surgery, University of Vermont, Colchester, VT
Timothy Emhoff, MD, Department of Surgery, University of Massachusetts Medical School, Worcester, MA
Hasan Alam, MD, Section of General Surgery, University of Michigan Health Systems, Ann Arbor, MI
Iyah K. Romm, BS, Bureau of Health Care Safety and Quality, Massachusetts Department of Public Health, Boston, MA
Selwyn Rogers Jr., MD, Department of Surgery, Temple University School of Medicine, Philadelphia, PA
Background: Understanding the role of health insurance in racial inequities in emergency medical care for traumatic injuries is important to policy considerations. Methods: We analyzed racial/ethnic disparities in emergency department (ED) mortality using data on the first ED visit for trauma treatment among patients aged 15 years and older in the Massachusetts Statewide Trauma Registry (2008-2010). Patients dead on arrival were excluded. Health insurance type was classified as Medicaid, Medicare, private and others. The analysis was stratified by insurance type and age group (<65y vs. >=65y), and adjusted for injury severity, sex, and age. Results: The 27,453 patients included 44.9% women, 83.4% non-Hispanic whites, 5.4% non-Hispanic blacks, 6.8% Hispanics, and 4.4% Asian or other races. In total, 534 (2.0%) died in ED. Compared to whites, blacks and Hispanics were more likely to be Medicaid beneficiaries (30% and 30% vs. 10%), less likely to be Medicare beneficiaries (14%, 11% vs. 43%). Among Medicaid beneficiaries aged under 65 years, blacks were twice more likely than whites to die in ED (OR=2.3, p=0.04). Among privately insured patients under 65 years of age, both blacks and Hispanics were twice more likely than whites to die in ED (OR=2.4, p<0.001; OR=2.1, p=0.003; respectively). Among Medicare beneficiaries aged 65 years and over, no significant racial/ethnic disparities were observed. Conclusions: Regardless of insurance type, significant black-white and Hispanic-white disparities in ED mortality existed among the trauma patients under 65 years of age. The role of insurance type in trauma care should be further investigated by age group.

Learning Areas:

Provision of health care to the public
Public health or related research

Learning Objectives:
Evaluate the potential impact of health insurance type on ED mortality among trauma patients. Discuss whether racial/ethnic differences in health insurance can explain racial/ethnic disparities in ED mortality.

Keyword(s): EMS/Trauma, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am Associate Professor of Medicine (Biostatistics). I am the principal investigator of the NIH-funded study "Health Care Reform and Disparities in the Care and Outcomes of Trauma Patients)". I have authored or co-authored over 70 articles in public health and biostatistics. I am Principal Investigator and co-Investigator for several NIH and CDC-funded national and regional studies. I published 5 artciles in AJPH which I am either the first or senior author.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.