Eric O Yeates1, Catherine Juillard2, Areg Grigorian3, Morgan Schellenberg4, Natthida Owattanapanich4, Galinos Barmparas5, Daniel Margulies5, Kent Garber2, Henry Cryer2, Areti Tillou2, Sigrid Burruss6, Liz Penaloza-Villalobos6, Ann Lin6, Ryan Arthur Figueras6, Megan Brenner7, Christopher Firek8, Todd Costantini9, Jarrett Santorelli9, Terry Curry9, Diane Wintz10, Walter L Biffl11, Kathryn B Schaffer11, Thomas K Duncan12, Casey Barbaro12, Graal Diaz12, Arianne Johnson13, Justine Chinn1, Ariana Naaseh1, Amanda Leung1, Christina Grabar1, Todd O Yeates14, Jeffry Nahmias15. 1. University of California, Irvine (UCI), Department of Surgery, Orange, CA. 2. University of California, Los Angeles (UCLA), Department of Surgery, Los Angeles, CA. 3. University of California, Irvine (UCI), Department of Surgery, Orange, CA; University of Southern California (USC), Department of Surgery, Los Angeles, CA. 4. University of Southern California (USC), Department of Surgery, Los Angeles, CA. 5. Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA. 6. Loma Linda University, Department of Surgery, Loma Linda, CA. 7. University of California, Riverside/Riverside University Health System Department of Surgery, Moreno Valley, CA. 8. Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System, Moreno Valley, CA. 9. University of California, San Diego (UCSD), Department of Surgery, San Diego, CA. 10. Sharp Memorial Hospital, Department of Surgery, San Diego, CA. 11. Scripps Memorial Hospital La Jolla, Trauma Department, La Jolla, CA. 12. Ventura County Medical Center, Department of Surgery, Ventura, CA. 13. Santa Barbara Cottage Hospital, Cottage Health Research Institute, Santa Barbara, CA. 14. University of California, Los Angeles (UCLA), Department of Chemistry and Biochemistry, Los Angeles, CA. 15. University of California, Irvine (UCI), Department of Surgery, Orange, CA. Electronic address: jnahmias@hs.uci.edu.
Abstract
BACKGROUND: The rapid spread of coronavirus disease 2019 in the United States led to a variety of mandates intended to decrease population movement and "flatten the curve." However, there is evidence some are not able to stay-at-home due to certain disadvantages, thus remaining exposed to both coronavirus disease 2019 and trauma. We therefore sought to identify any unequal effects of the California stay-at-home orders between races and insurance statuses in a multicenter study utilizing trauma volume data. METHODS: A posthoc multicenter retrospective analysis of trauma patients presenting to 11 centers in Southern California between the dates of January 1, 2020, and June 30, 2020, and January 1, 2019, and June 30, 2019, was performed. The number of trauma patients of each race/insurance status was tabulated per day. We then calculated the changes in trauma volume related to stay-at-home orders for each race/insurance status and compared the magnitude of these changes using statistical resampling. RESULTS: Compared to baseline, there was a 40.1% drop in total trauma volume, which occurred 20 days after stay-at-home orders. During stay-at-home orders, the average daily trauma volume of patients with Medicaid increased by 13.7 ± 5.3%, whereas the volume of those with Medicare, private insurance, and no insurance decreased. The average daily trauma volume decreased for White, Black, Asian, and Latino patients with the volume of Black and Latino patients dropping to a similar degree compared to White patients. CONCLUSION: This retrospective multicenter study demonstrated that patients with Medicaid had a paradoxical increase in trauma volume during stay-at-home orders, suggesting that the most impoverished groups remain disproportionately exposed to trauma during a pandemic, further exacerbating existing health disparities.
BACKGROUND: The rapid spread of coronavirus disease 2019 in the United States led to a variety of mandates intended to decrease population movement and "flatten the curve." However, there is evidence some are not able to stay-at-home due to certain disadvantages, thus remaining exposed to both coronavirus disease 2019 and trauma. We therefore sought to identify any unequal effects of the California stay-at-home orders between races and insurance statuses in a multicenter study utilizing trauma volume data. METHODS: A posthoc multicenter retrospective analysis of traumapatients presenting to 11 centers in Southern California between the dates of January 1, 2020, and June 30, 2020, and January 1, 2019, and June 30, 2019, was performed. The number of traumapatients of each race/insurance status was tabulated per day. We then calculated the changes in trauma volume related to stay-at-home orders for each race/insurance status and compared the magnitude of these changes using statistical resampling. RESULTS: Compared to baseline, there was a 40.1% drop in total trauma volume, which occurred 20 days after stay-at-home orders. During stay-at-home orders, the average daily trauma volume of patients with Medicaid increased by 13.7 ± 5.3%, whereas the volume of those with Medicare, private insurance, and no insurance decreased. The average daily trauma volume decreased for White, Black, Asian, and Latino patients with the volume of Black and Latino patients dropping to a similar degree compared to White patients. CONCLUSION: This retrospective multicenter study demonstrated that patients with Medicaid had a paradoxical increase in trauma volume during stay-at-home orders, suggesting that the most impoverished groups remain disproportionately exposed to trauma during a pandemic, further exacerbating existing health disparities.
Authors: Perisa Ruhi-Williams; Eric O Yeates; Areg Grigorian; Morgan Schellenberg; Natthida Owattanapanich; Galinos Barmparas; Daniel Margulies; Catherine Juillard; Kent Garber; Henry Cryer; Areti Tillou; Sigrid Burruss; Liz Penaloza-Villalobos; Ann Lin; Ryan Arthur Figueras; Raul Coimbra; Megan Brenner; Todd Costantini; Jarrett Santorelli; Terry Curry; Diane Wintz; Walter L Biffl; Kathryn B Schaffer; Thomas K Duncan; Casey Barbaro; Graal Diaz; Arianne Johnson; Justine Chinn; Ariana Naaseh; Amanda Leung; Christina Grabar; Jeffry Nahmias Journal: Am Surg Date: 2022-05-18 Impact factor: 1.002
Authors: Eric O Yeates; Areg Grigorian; Morgan Schellenberg; Natthida Owattanapanich; Galinos Barmparas; Daniel Margulies; Catherine Juillard; Kent Garber; Henry Cryer; Areti Tillou; Sigrid Burruss; Liz Penaloza-Villalobos; Ann Lin; Ryan Arthur Figueras; Raul Coimbra; Megan Brenner; Todd Costantini; Jarrett Santorelli; Terry Curry; Diane Wintz; Walter L Biffl; Kathryn B Schaffer; Thomas K Duncan; Casey Barbaro; Graal Diaz; Arianne Johnson; Justine Chinn; Ariana Naaseh; Amanda Leung; Christina Grabar; Jeffry Nahmias Journal: Pediatr Surg Int Date: 2021-12-01 Impact factor: 1.827