Association between race and age in survival after trauma

Caitlin Hicks, Zain G. Hashmi, Catherine Velopulos, David Thomas Efron, Eric B. Schneider, Elliott Haut, Edward E. Cornwell, Adil H. Haider

Research output: Contribution to journalArticle

Abstract

IMPORTANCE: Racial disparities in survival after trauma are well described for patients younger than 65 years. Similar information among older patients is lacking because existing trauma databases do not include important patient comorbidity information. OBJECTIVE: To determine whether racial disparities in trauma survival persist in patients 65 years or older. DESIGN, SETTING, AND PARTICIPANTS: Trauma patientswere identified from the Nationwide Inpatient Sample (January 1, 2003, through December 30, 2010) using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Injury severity was ascertained by applying the Trauma Mortality Prediction Model, and patient comorbidities were quantified using the Charlson Comorbidity Index. MAIN OUTCOMES AND MEASURES: In-hospital mortality after trauma for blacks vs whites for younger (16-64 years of age) and older (≥65 years of age) patients was compared using 3 different statistical methods: univariable logistic regression, multivariable logistic regression with and without clustering for hospital effects, and coarsened exact matching. Model covariates included age, sex, insurance status, type and intent of injury, injury severity, head injury severity, and Charlson Comorbidity Index. RESULTS: A total of 1 073 195 patients were included (502 167 patients 16-64 years of age and 571 028 patients ≥65 years of age). Most older patients were white (547 325 [95.8%]), female (406 158 [71.1%]), and insured (567 361 [99.4%]) and had Charlson Comorbidity Index scores of 1 or higher (323 741 [56.7%]). The unadjusted odds ratios (ORs) for death in blacks vs whites were 1.35 (95%CI, 1.28-1.42) for patients 16 to 64 years of age and 1.00 (95%CI, 0.93-1.08) for patients 65 years or older. After risk adjustment, racial disparities in survival persisted in the younger black group (OR, 1.21; 95%CI, 1.13-1.30) but were reversed in the older group (OR, 0.83; 95%CI, 0.76-0.90). This finding was consistent across all 3 statistical methods. CONCLUSIONS AND RELEVANCE: Different racial disparities in survival after trauma exist between white and black patients depending on their age group. Although younger white patients have better outcomes after trauma than younger black patients, older black patients have better outcomes than older white patients. Exploration of this paradoxical findingmay lead to a better understanding of the mechanisms that cause disparities in trauma outcomes.

Original languageEnglish (US)
Pages (from-to)642-647
Number of pages6
JournalJAMA Surgery
Volume149
Issue number7
DOIs
StatePublished - 2014

Fingerprint

Survival
Wounds and Injuries
Comorbidity
Odds Ratio
Logistic Models
Risk Adjustment
Insurance Coverage
International Classification of Diseases
Hospital Mortality
Craniocerebral Trauma
Cluster Analysis
Inpatients
Age Groups
Databases
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

Hicks, C., Hashmi, Z. G., Velopulos, C., Efron, D. T., Schneider, E. B., Haut, E., ... Haider, A. H. (2014). Association between race and age in survival after trauma. JAMA Surgery, 149(7), 642-647. https://doi.org/10.1001/jamasurg.2014.166

Association between race and age in survival after trauma. / Hicks, Caitlin; Hashmi, Zain G.; Velopulos, Catherine; Efron, David Thomas; Schneider, Eric B.; Haut, Elliott; Cornwell, Edward E.; Haider, Adil H.

In: JAMA Surgery, Vol. 149, No. 7, 2014, p. 642-647.

Research output: Contribution to journalArticle

Hicks, C, Hashmi, ZG, Velopulos, C, Efron, DT, Schneider, EB, Haut, E, Cornwell, EE & Haider, AH 2014, 'Association between race and age in survival after trauma', JAMA Surgery, vol. 149, no. 7, pp. 642-647. https://doi.org/10.1001/jamasurg.2014.166
Hicks, Caitlin ; Hashmi, Zain G. ; Velopulos, Catherine ; Efron, David Thomas ; Schneider, Eric B. ; Haut, Elliott ; Cornwell, Edward E. ; Haider, Adil H. / Association between race and age in survival after trauma. In: JAMA Surgery. 2014 ; Vol. 149, No. 7. pp. 642-647.
@article{3b13ff3b03ef4489b1e6d2d31c9146ba,
title = "Association between race and age in survival after trauma",
abstract = "IMPORTANCE: Racial disparities in survival after trauma are well described for patients younger than 65 years. Similar information among older patients is lacking because existing trauma databases do not include important patient comorbidity information. OBJECTIVE: To determine whether racial disparities in trauma survival persist in patients 65 years or older. DESIGN, SETTING, AND PARTICIPANTS: Trauma patientswere identified from the Nationwide Inpatient Sample (January 1, 2003, through December 30, 2010) using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Injury severity was ascertained by applying the Trauma Mortality Prediction Model, and patient comorbidities were quantified using the Charlson Comorbidity Index. MAIN OUTCOMES AND MEASURES: In-hospital mortality after trauma for blacks vs whites for younger (16-64 years of age) and older (≥65 years of age) patients was compared using 3 different statistical methods: univariable logistic regression, multivariable logistic regression with and without clustering for hospital effects, and coarsened exact matching. Model covariates included age, sex, insurance status, type and intent of injury, injury severity, head injury severity, and Charlson Comorbidity Index. RESULTS: A total of 1 073 195 patients were included (502 167 patients 16-64 years of age and 571 028 patients ≥65 years of age). Most older patients were white (547 325 [95.8{\%}]), female (406 158 [71.1{\%}]), and insured (567 361 [99.4{\%}]) and had Charlson Comorbidity Index scores of 1 or higher (323 741 [56.7{\%}]). The unadjusted odds ratios (ORs) for death in blacks vs whites were 1.35 (95{\%}CI, 1.28-1.42) for patients 16 to 64 years of age and 1.00 (95{\%}CI, 0.93-1.08) for patients 65 years or older. After risk adjustment, racial disparities in survival persisted in the younger black group (OR, 1.21; 95{\%}CI, 1.13-1.30) but were reversed in the older group (OR, 0.83; 95{\%}CI, 0.76-0.90). This finding was consistent across all 3 statistical methods. CONCLUSIONS AND RELEVANCE: Different racial disparities in survival after trauma exist between white and black patients depending on their age group. Although younger white patients have better outcomes after trauma than younger black patients, older black patients have better outcomes than older white patients. Exploration of this paradoxical findingmay lead to a better understanding of the mechanisms that cause disparities in trauma outcomes.",
author = "Caitlin Hicks and Hashmi, {Zain G.} and Catherine Velopulos and Efron, {David Thomas} and Schneider, {Eric B.} and Elliott Haut and Cornwell, {Edward E.} and Haider, {Adil H.}",
year = "2014",
doi = "10.1001/jamasurg.2014.166",
language = "English (US)",
volume = "149",
pages = "642--647",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "7",

}

TY - JOUR

T1 - Association between race and age in survival after trauma

AU - Hicks, Caitlin

AU - Hashmi, Zain G.

AU - Velopulos, Catherine

AU - Efron, David Thomas

AU - Schneider, Eric B.

AU - Haut, Elliott

AU - Cornwell, Edward E.

AU - Haider, Adil H.

PY - 2014

Y1 - 2014

N2 - IMPORTANCE: Racial disparities in survival after trauma are well described for patients younger than 65 years. Similar information among older patients is lacking because existing trauma databases do not include important patient comorbidity information. OBJECTIVE: To determine whether racial disparities in trauma survival persist in patients 65 years or older. DESIGN, SETTING, AND PARTICIPANTS: Trauma patientswere identified from the Nationwide Inpatient Sample (January 1, 2003, through December 30, 2010) using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Injury severity was ascertained by applying the Trauma Mortality Prediction Model, and patient comorbidities were quantified using the Charlson Comorbidity Index. MAIN OUTCOMES AND MEASURES: In-hospital mortality after trauma for blacks vs whites for younger (16-64 years of age) and older (≥65 years of age) patients was compared using 3 different statistical methods: univariable logistic regression, multivariable logistic regression with and without clustering for hospital effects, and coarsened exact matching. Model covariates included age, sex, insurance status, type and intent of injury, injury severity, head injury severity, and Charlson Comorbidity Index. RESULTS: A total of 1 073 195 patients were included (502 167 patients 16-64 years of age and 571 028 patients ≥65 years of age). Most older patients were white (547 325 [95.8%]), female (406 158 [71.1%]), and insured (567 361 [99.4%]) and had Charlson Comorbidity Index scores of 1 or higher (323 741 [56.7%]). The unadjusted odds ratios (ORs) for death in blacks vs whites were 1.35 (95%CI, 1.28-1.42) for patients 16 to 64 years of age and 1.00 (95%CI, 0.93-1.08) for patients 65 years or older. After risk adjustment, racial disparities in survival persisted in the younger black group (OR, 1.21; 95%CI, 1.13-1.30) but were reversed in the older group (OR, 0.83; 95%CI, 0.76-0.90). This finding was consistent across all 3 statistical methods. CONCLUSIONS AND RELEVANCE: Different racial disparities in survival after trauma exist between white and black patients depending on their age group. Although younger white patients have better outcomes after trauma than younger black patients, older black patients have better outcomes than older white patients. Exploration of this paradoxical findingmay lead to a better understanding of the mechanisms that cause disparities in trauma outcomes.

AB - IMPORTANCE: Racial disparities in survival after trauma are well described for patients younger than 65 years. Similar information among older patients is lacking because existing trauma databases do not include important patient comorbidity information. OBJECTIVE: To determine whether racial disparities in trauma survival persist in patients 65 years or older. DESIGN, SETTING, AND PARTICIPANTS: Trauma patientswere identified from the Nationwide Inpatient Sample (January 1, 2003, through December 30, 2010) using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Injury severity was ascertained by applying the Trauma Mortality Prediction Model, and patient comorbidities were quantified using the Charlson Comorbidity Index. MAIN OUTCOMES AND MEASURES: In-hospital mortality after trauma for blacks vs whites for younger (16-64 years of age) and older (≥65 years of age) patients was compared using 3 different statistical methods: univariable logistic regression, multivariable logistic regression with and without clustering for hospital effects, and coarsened exact matching. Model covariates included age, sex, insurance status, type and intent of injury, injury severity, head injury severity, and Charlson Comorbidity Index. RESULTS: A total of 1 073 195 patients were included (502 167 patients 16-64 years of age and 571 028 patients ≥65 years of age). Most older patients were white (547 325 [95.8%]), female (406 158 [71.1%]), and insured (567 361 [99.4%]) and had Charlson Comorbidity Index scores of 1 or higher (323 741 [56.7%]). The unadjusted odds ratios (ORs) for death in blacks vs whites were 1.35 (95%CI, 1.28-1.42) for patients 16 to 64 years of age and 1.00 (95%CI, 0.93-1.08) for patients 65 years or older. After risk adjustment, racial disparities in survival persisted in the younger black group (OR, 1.21; 95%CI, 1.13-1.30) but were reversed in the older group (OR, 0.83; 95%CI, 0.76-0.90). This finding was consistent across all 3 statistical methods. CONCLUSIONS AND RELEVANCE: Different racial disparities in survival after trauma exist between white and black patients depending on their age group. Although younger white patients have better outcomes after trauma than younger black patients, older black patients have better outcomes than older white patients. Exploration of this paradoxical findingmay lead to a better understanding of the mechanisms that cause disparities in trauma outcomes.

UR - http://www.scopus.com/inward/record.url?scp=84904382641&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84904382641&partnerID=8YFLogxK

U2 - 10.1001/jamasurg.2014.166

DO - 10.1001/jamasurg.2014.166

M3 - Article

C2 - 24871941

AN - SCOPUS:84904382641

VL - 149

SP - 642

EP - 647

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 7

ER -