ArticleJournal of racial and ethnic health disparities2026
Impact of Race, Ethnicity, and Insurance Type on In-hospital Mortality in Children with Traumatic Injury.
Article in Journal of racial and ethnic health disparities, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
objectiveTo evaluate the association of insurance status and race/ethnicity with in-hospital mortality among pediatric trauma patients.
methodsWe conducted a retrospective cohort study using the National Trauma Data Bank (2007-2019, excluding 2018). Patients younger than 17 years with an Injury Severity Score > 9 were included. Multivariable logistic regression was used to assess the independent and combined associations of race/ethnicity and insurance status with in-hospital mortality, adjusting for age, sex, injury severity, Glasgow Coma Scale, and mechanism of injury.
resultsA total of 148,019 pediatric patients were included (66% male; median age 11 years [IQR 5-15]). Non-Hispanic White children comprised 60% of the cohort, followed by Hispanic (15%) and Non-Hispanic Black (15%). Private (38%) and Medicaid (32%) were the most common insurance types; 7.6% were self-pay. Overall mortality was 4.4%, highest among Non-Hispanic Black children (6.6%) and self-pay patients (7.5%). In adjusted analyses, self-pay status was associated with increased mortality compared with Medicaid (OR 1.23, 95% CI 1.12--0.36), as was Non-Hispanic Black race (OR 1.15, 95% CI 1.06-1.24). Firearm-related injury was strongly associated with mortality (OR 4.18, 95% CI 3.59-4.86). No significant interaction was observed between race/ethnicity and insurance status.
conclusionsInsurance status is an independent predictor of mortality in pediatric trauma, with self-pay patients at highest risk. Racial disparities were attenuated after adjustment, and the effect of insurance was consistent across racial and ethnic groups.
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