Muhammad Ali Chaudhary1, Meesha Sharma1, Rebecca E Scully1, Daniel J Sturgeon1, Tracey Koehlmoos2, Adil H Haider1, Andrew J Schoenfeld3. 1. Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 2. Uniformed Services University of Health Sciences, Bethesda, MD. 3. Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: ajschoen@neomed.edu.
Abstract
BACKGROUND: Although inequities in trauma care are reported widely, some groups have theorized that universal health insurance would decrease disparities in care for disadvantaged minorities after a traumatic injury. We sought to examine the presence of racial disparities in outcomes and healthcare utilization at 30- and 90-days after discharge in this universally insured, racially diverse, American population treated for traumatic injuries. METHODS: This work studied adult beneficiaries of TRICARE treated at both military and civilian trauma centers 2006-2014. We included patients with an inpatient trauma encounter based on International Classification of Diseases, 9th revision (ICD-9) code. The mechanism and severity of injury, medical comorbidities, region and environment of care, and demographic factors were used as covariates. Race was considered the main predictor variable with Black patients compared to Whites. Logistic regression models were employed to assess for risk-adjusted differences in 30- and 90-day outcomes between Blacks and Whites. RESULTS: A total of 87,112 patients met the inclusion criteria. Traditionally encountered disparities for Black patients after trauma, including increased rates of mortality, were absent. We found a statistically significant decrease in the odds of 90-day complications for Blacks (OR 0.91; 95% CI 0.84-0.98; P = 0.01). Blacks also had lesser odds of readmission at 30-days (OR 0.87; 95% CI 0.79-0.94; P = 0.002) and 90-days (OR 0.86; 95% CI 0.79-0.93; P < 0.001). CONCLUSION: Our findings support the idea that in a universally insured, equal access system, historic disparities for racial and ethnic minorities, including increased postinjury morbidity, hospital readmission, and postdischarge healthcare utilization, are decreased or even eliminated.
BACKGROUND: Although inequities in trauma care are reported widely, some groups have theorized that universal health insurance would decrease disparities in care for disadvantaged minorities after a traumatic injury. We sought to examine the presence of racial disparities in outcomes and healthcare utilization at 30- and 90-days after discharge in this universally insured, racially diverse, American population treated for traumatic injuries. METHODS: This work studied adult beneficiaries of TRICARE treated at both military and civilian trauma centers 2006-2014. We included patients with an inpatient trauma encounter based on International Classification of Diseases, 9th revision (ICD-9) code. The mechanism and severity of injury, medical comorbidities, region and environment of care, and demographic factors were used as covariates. Race was considered the main predictor variable with Black patients compared to Whites. Logistic regression models were employed to assess for risk-adjusted differences in 30- and 90-day outcomes between Blacks and Whites. RESULTS: A total of 87,112 patients met the inclusion criteria. Traditionally encountered disparities for Black patients after trauma, including increased rates of mortality, were absent. We found a statistically significant decrease in the odds of 90-day complications for Blacks (OR 0.91; 95% CI 0.84-0.98; P = 0.01). Blacks also had lesser odds of readmission at 30-days (OR 0.87; 95% CI 0.79-0.94; P = 0.002) and 90-days (OR 0.86; 95% CI 0.79-0.93; P < 0.001). CONCLUSION: Our findings support the idea that in a universally insured, equal access system, historic disparities for racial and ethnic minorities, including increased postinjury morbidity, hospital readmission, and postdischarge healthcare utilization, are decreased or even eliminated.
Authors: Muhammad Ali Chaudhary; Jeffrey K Lange; Linda M Pak; Justin A Blucher; Lauren B Barton; Daniel J Sturgeon; Tracey Koehlmoos; Adil H Haider; Andrew J Schoenfeld Journal: Clin Orthop Relat Res Date: 2018-08 Impact factor: 4.176
Authors: Carly Eckert; Neris Nieves-Robbins; Elena Spieker; Tom Louwers; David Hazel; James Marquardt; Keith Solveson; Anam Zahid; Muhammad Ahmad; Richard Barnhill; T Greg McKelvey; Robert Marshall; Eric Shry; Ankur Teredesai Journal: Appl Clin Inform Date: 2019-05-08 Impact factor: 2.342
Authors: Jason D Young; Edward C Dee; Adele Levine; Daniel J Sturgeon; Tracey P Koehlmoos; Andrew J Schoenfeld Journal: Clin Orthop Relat Res Date: 2020-07 Impact factor: 4.755
Authors: Athanasios Burlotos; Paola Alejandra Vargas Díaz; Manuel Alejandro Hernández Pacheco; Lorena Daniela Ponce de León Angel; Miriam Morales Camas; Jesús Sepulveda-Delgado; José Manuel Pérez-Tirado; Santiago Ortiz-Barragan; Anthony T Fuller; Gustavo Nigenda Journal: Ann Glob Health Date: 2022-04-06 Impact factor: 2.462