TY - JOUR
T1 - Pedestrians struck by motor vehicles further worsen race- and insurance-based disparities in trauma outcomes
T2 - The case for inner-city pedestrian injury prevention programs
AU - Maybury, Rubie Sue
AU - Bolorunduro, Oluwaseyi B.
AU - Villegas, Cassandra
AU - Haut, Elliott R.
AU - Stevens, Kent
AU - Cornwell, Edward E.
AU - Efron, David T.
AU - Haider, Adil H.
PY - 2010
Y1 - 2010
N2 - Background: Pedestrian trauma is the most lethal blunt trauma mechanism, and the rate of mortality in African Americans and Hispanics is twice that compared with whites. Whether insurance status and differential survival contribute to this disparity is unknown. Methods: This study is a review of vehicle-struck pedestrians in the National Trauma Data Bank, v7.0. Patients <16 years and ≥65 years, as well as patients with Injury Severity Score (ISS) <9, were excluded. Patients were categorized as white, African American, or Hispanic, and as privately insured, government insured, or uninsured. With white and privately insured patients as reference, logistic regression was used to evaluate mortality by race and insurance status after adjusting for patient and injury characteristics. Results: In all, 26,404 patients met inclusion criteria. On logistic regression, African Americans had 22% greater odds of mortality (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.06-1.41) and Hispanics had 33% greater odds of mortality (OR, 1.33; 95% CI, 1.14-1.54) compared with whites. Uninsured patients had 77% greater odds of mortality (OR, 1.77; 95% CI, 1.52-2.06) compared with privately insured patients. Conclusion: African American and Hispanic race, as well as uninsured status, increase the risk of mortality after pedestrian crashes. Given the greater incidence of pedestrian crashes in minorities, this compounded burden of injury mandates pedestrian trauma prevention efforts in inner cities to decrease health disparities.
AB - Background: Pedestrian trauma is the most lethal blunt trauma mechanism, and the rate of mortality in African Americans and Hispanics is twice that compared with whites. Whether insurance status and differential survival contribute to this disparity is unknown. Methods: This study is a review of vehicle-struck pedestrians in the National Trauma Data Bank, v7.0. Patients <16 years and ≥65 years, as well as patients with Injury Severity Score (ISS) <9, were excluded. Patients were categorized as white, African American, or Hispanic, and as privately insured, government insured, or uninsured. With white and privately insured patients as reference, logistic regression was used to evaluate mortality by race and insurance status after adjusting for patient and injury characteristics. Results: In all, 26,404 patients met inclusion criteria. On logistic regression, African Americans had 22% greater odds of mortality (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.06-1.41) and Hispanics had 33% greater odds of mortality (OR, 1.33; 95% CI, 1.14-1.54) compared with whites. Uninsured patients had 77% greater odds of mortality (OR, 1.77; 95% CI, 1.52-2.06) compared with privately insured patients. Conclusion: African American and Hispanic race, as well as uninsured status, increase the risk of mortality after pedestrian crashes. Given the greater incidence of pedestrian crashes in minorities, this compounded burden of injury mandates pedestrian trauma prevention efforts in inner cities to decrease health disparities.
UR - http://www.scopus.com/inward/record.url?scp=77955302126&partnerID=8YFLogxK
U2 - 10.1016/j.surg.2010.05.010
DO - 10.1016/j.surg.2010.05.010
M3 - Article
C2 - 20633726
AN - SCOPUS:77955302126
SN - 0039-6060
VL - 148
SP - 202
EP - 208
JO - Surgery
JF - Surgery
IS - 2
ER -