Disparities in mortality after blunt injury: Does insurance type matter?

Paul Logan Weygandt, Lia I. Losonczy, Eric B. Schneider, Mehreen T. Kisat, Lauren K. Licatino, Edward E. Cornwell, Elliot R. Haut, David T. Efron, Adil H. Haider

Research output: Contribution to journalArticlepeer-review

36 Citations (Scopus)


Background: Insurance-related outcomes disparities are well-known, but associations between distinct insurance types and trauma outcomes remain unclear. Prior studies have generally merged various insurance types into broad groups. The purpose of this study is to determine the association of specific insurance types with mortality after blunt injury. Materials and methods: Cases of blunt injury among adults aged 18-64 y with an injury severity score >9 were identified using the 2007-2009 National Trauma Data Bank. Crude mortality was calculated for 10 insurance types. Multivariable logistic regression was employed to determine difference in odds of death between insurance types, controlling for injury severity score, Glasgow Coma Scale motor, mechanism of injury, sex, race, and hypotension. Clustering was used to account for possible inter-facility variations. Results: A total of 312,312 cases met inclusion criteria. Crude mortality ranged from 3.2 to 6.0% by insurance type. Private Insurance, Blue Cross Blue Shield, Workers Compensation, and Medicaid yielded the lowest relative odds of death, while Not Billed and Self Pay yielded the highest. Compared with Private Insurance, odds of death were higher for No Fault (OR 1.25, P = 0.022), Not Billed (OR 1.77, P < 0.001), and Self Pay (OR 1.77, P < 0.001). Odds of death were higher for Medicare (OR 1.52, P < 0.001) and Other Government (OR 1.35, P = 0.049), while odds of death were lower for Medicaid (OR 0.89, P = 0.015). Conclusions: Significant differences in mortality after blunt injury were seen between insurance types, even among those commonly grouped in other studies. Policymakers may use this information to implement programs to monitor and reduce insurance-related disparities.

Original languageEnglish
Pages (from-to)288-294
Number of pages7
JournalJournal of Surgical Research
Issue number2
Publication statusPublished - Oct 2012
Externally publishedYes


  • Blunt injury
  • Disparities
  • Insurance type
  • Outcomes


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