ArticleThe western journal of emergency medicine2015
Association of insurance status with health outcomes following traumatic injury: statewide multicenter analysis.
Article in The western journal of emergency medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Disparities in Adult and Pediatric Trauma Outcomes: a Systematic Review and Meta-Analysis.World journal of surgery · 2020Pooled it
- Impact of Race, Ethnicity, and Insurance Type on In-hospital Mortality in Children with Traumatic Injury.Journal of racial and ethnic health disparities · 2026Article
- Trauma care disparities: is equity the key? Output from SAFER-Trauma.Trauma surgery & acute care open · 2025Review
- Age-Neutral Surgical Stabilization of Rib Fractures: Breaking the Ageism Barrier.The Journal of surgical research · 2024Article
- Insurance Type and Withdrawal of Life-Sustaining Therapy in Critically Injured Trauma Patients.JAMA network open · 2024Article
- The role of race and insurance in trauma patients' mortality: A cross-sectional analysis based on a nationwide sample.PloS one · 2024Article
- Insurance status and traumatized patients' outcomes: a report from the national trauma registry of Iran.BMC health services research · 2023Article
- Socioeconomic Factors and Pediatric Injury.Current trauma reports · 2023Review
- Risk Factors for Dual Burden of Severe Maternal Morbidity and Preterm Birth by Insurance Type in California.Maternal and child health journal · 2022Article
- "Making It Work": A Preliminary Mixed Methods Study of Rural Trauma Care Access and Resources in New Mexico.Cureus · 2020Article
- Insurance Does Not Affect Adverse Events While Awaiting Surgery for Ankle Trauma in One System.The western journal of emergency medicine · 2020Article
- An investigation of social determinants of health and outcomes in pediatric nonaccidental trauma.Pediatric surgery international · 2019Article
- The impact of socioeconomic status on emergency department outcome in a low-income country setting: A registry-based analysis.PloS one · 2019Article
- Association of Expanded Medicaid Coverage With Hospital Length of Stay After Injury.JAMA surgery · 2017Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionRecognizing disparities in definitive care for traumatic injuries created by insurance status may help reduce the higher risk of trauma-related mortality in this population. Our objective was to understand the relationship between patients' insurance status and trauma outcomes.
methodsWe collected data on all patients involved in traumatic injury from eight Level I and 15 Level IV trauma centers, and four non-designated hospitals through Arizona State Trauma Registry between January 1, 2008 and December 31, 2011. Of 109,497 records queried, we excluded 29,062 (26.5%) due to missing data on primary payer, sex, race, zip code of residence, injury severity score (ISS), and alcohol or drug use. Of the 80,435 cases analyzed, 13.3% were self-pay, 38.8% were Medicaid, 13% were Medicare, and 35% were private insurance. We evaluated the association between survival and insurance status (private insurance, Medicare, Medicaid, and self-pay) using multiple logistic regression analyses after adjusting for race/ethnicity (White, Black/African American, Hispanic, and American Indian/Alaska Native), age, gender, income, ISS and injury type (penetrating or blunt).
resultsThe self-pay group was more likely to suffer from penetrating trauma (18.2%) than the privately insured group (6.0%), p<0.0001. There were more non-White (53%) self-pay patients compared to the private insurance group (28.3%), p<0.0001. Additionally, the self-pay group had significantly higher mortality (4.3%) as compared to private insurance (1.9%), p<0.0001. A simple logistic regression revealed higher mortality for self-pay patients (crude OR= 2.32, 95% CI [2.07-2.67]) as well as Medicare patients (crude OR= 2.35, 95% CI [2.54-3.24]) as compared to private insurance. After adjusting for confounding, a multiple logistic regression revealed that mortality was highest for self-pay patients as compared to private insurance (adjusted OR= 2.76, 95% CI [2.30-3.32]).
conclusionThese results demonstrate that after controlling for confounding variables, self-pay patients had a significantly higher risk of mortality following a traumatic injury as compared to any other insurance-type groups. Further research is warranted to understand this finding and possibly decrease the mortality rate in this population.
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