Alan Cook1, Kristina Chapple2, Neil Motzkin3, Jeanette Ward2, Forrest Moore2. 1. Trauma Program, Chandler Regional Medical Center, 485 South Dobson Rd, Suite 201, Chandler, AZ, 85224, USA. alan.cook@dignityhealth.org. 2. Trauma Program, Chandler Regional Medical Center, 485 South Dobson Rd, Suite 201, Chandler, AZ, 85224, USA. 3. Orthopedic Trauma Program, Chandler Regional Medical Center, 485 South Dobson Rd, Suite 201, Chandler, AZ, 85224, USA.
Abstract
BACKGROUND: Racial/ethnic disparities in trauma care have been reported. The American Indian/Alaska Native (AI/AN) population faces a twofold to fourfold increase of risk for traumatic injury. We hypothesized that surgical intervention and time to surgery were associated with race/ethnicity, specifically AI/AN compared to other race/ethnicity groups with open pelvic and lower extremity fractures (OPLEFx). METHODS: Non-AI/AN racial/ethnic groups were compared to AI/ANs among adults aged 15 years and older using the National Trauma Data Bank for 2008-2012. OPLEFx were identified via ICD-9-CM. Predictors of surgery and time to surgery were modeled via logistic regression and survival analyses. RESULTS: AI/AN patients (2.7 %, n = 206) were younger (36 ± 16 versus 41 ± 18 years, p < 0.001) and more likely to have Medicaid and other government insurance. There were no differences in AI/ANs versus non-AI/ANs undergoing surgery (88.4 versus 86.8 %, respectively) or time to surgery (11.7 ± 25.3 versus 12.0 ± 22.5 h, respectively). Injury severity was predictive of surgery in all six models (OR = 0.04 to 0.32). A race-gender interaction increased odds of surgery in the AI/AN versus all other races model (OR = 3.58, 95 % CI 1.18-10.84) and in three of five pairwise models. Median time to surgery varied by race, favoring AI/ANs with least preoperative time. CONCLUSION: The AI/AN population experienced no disparities in rate of, or time to, OPLEFx surgery. Race-specific predictors for surgery included gender, probability of death, and multiple fractures. More study is warranted to ameliorate trauma care disparities and achieve reasonably equitable care as demonstrated in AI/ANs with OPLEFx.
BACKGROUND: Racial/ethnic disparities in trauma care have been reported. The American Indian/Alaska Native (AI/AN) population faces a twofold to fourfold increase of risk for traumatic injury. We hypothesized that surgical intervention and time to surgery were associated with race/ethnicity, specifically AI/AN compared to other race/ethnicity groups with open pelvic and lower extremity fractures (OPLEFx). METHODS: Non-AI/AN racial/ethnic groups were compared to AI/ANs among adults aged 15 years and older using the National Trauma Data Bank for 2008-2012. OPLEFx were identified via ICD-9-CM. Predictors of surgery and time to surgery were modeled via logistic regression and survival analyses. RESULTS: AI/AN patients (2.7 %, n = 206) were younger (36 ± 16 versus 41 ± 18 years, p < 0.001) and more likely to have Medicaid and other government insurance. There were no differences in AI/ANs versus non-AI/ANs undergoing surgery (88.4 versus 86.8 %, respectively) or time to surgery (11.7 ± 25.3 versus 12.0 ± 22.5 h, respectively). Injury severity was predictive of surgery in all six models (OR = 0.04 to 0.32). A race-gender interaction increased odds of surgery in the AI/AN versus all other races model (OR = 3.58, 95 % CI 1.18-10.84) and in three of five pairwise models. Median time to surgery varied by race, favoring AI/ANs with least preoperative time. CONCLUSION: The AI/AN population experienced no disparities in rate of, or time to, OPLEFx surgery. Race-specific predictors for surgery included gender, probability of death, and multiple fractures. More study is warranted to ameliorate trauma care disparities and achieve reasonably equitable care as demonstrated in AI/ANs with OPLEFx.
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