TY - JOUR
T1 - Factors mediating demographic determinants of injury mortality
AU - Jarman, Molly P.
AU - Pollack Porter, Keshia
AU - Curriero, Frank C.
AU - Castillo, Renan C.
N1 - Funding Information:
The authors thank Dr. William Thompson, John New, Shanae Williams, Tefferra Alemayehu, and the Maryland Institute for Emergency Medical Services Systems for their support of the project. M.P.J.'s effort for this study was supported by an Agency for Healthcare Research Quality training grant (T32HS000029)and by the Johns Hopkins Center for Injury Research and Policy (William Haddon Jr. Fellowship). The Agency for Healthcare Research and Quality had no role in the study design; the collection, analysis, and interpretation of the data; in writing of the report; and in the decision to submit the article for publication. R.C.C. and K.P.P. are affiliated with the Johns Hopkins Center for Injury Research and Policy. Other than their contributions as authors of this study, the Johns Hopkins Center for Injury Research and Policy had no role in the study design; the collection, analysis, and interpretation of the data; in writing of the report; and in the decision to submit the article for publication.
Funding Information:
M.P.J.'s effort for this study was supported by an Agency for Healthcare Research Quality training grant ( T32HS000029 ) and by the Johns Hopkins Center for Injury Research and Policy (William Haddon Jr. Fellowship). The Agency for Healthcare Research and Quality had no role in the study design; the collection, analysis, and interpretation of the data; in writing of the report; and in the decision to submit the article for publication. R.C.C. and K.P.P. are affiliated with the Johns Hopkins Center for Injury Research and Policy. Other than their contributions as authors of this study, the Johns Hopkins Center for Injury Research and Policy had no role in the study design; the collection, analysis, and interpretation of the data; in writing of the report; and in the decision to submit the article for publication.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/6
Y1 - 2019/6
N2 - Purpose: Elevated injury mortality rates persist for men and people of color despite attempts to standardize trauma care in the United States. This study investigates the role of injury characteristics and access to trauma care as mediators of the relationships between race, ethnicity, sex, and injury mortality. Methods: Data on prehospital and trauma center care were examined for adult injured patients in Maryland who were transported by emergency medical services to designated trauma centers (n = 15,355)or who died while under emergency medical services care (n = 727). Potential mediators of the relationship between demographic characteristics and injury mortality were identified through exploratory analyses. Total, direct, and indirect effects of race, ethnicity, and sex were estimated using multivariable mediation models. Results: Prehospital time, hospital distance, injury mechanism, and insurance status mediated the effect of African American race, resulting in a 5.7% total increase (95% CI: 1.6%, 9.9%)and 5.6% direct decrease (95% CI: 1.1%, 9.9%)in odds of death. Mechanism, insurance, and distance mediated the effect of Hispanic ethnicity, resulting in an 11.4% total decrease (95% CI: 6.4%, 16.2%)and 13.4% direct decrease (95% CI: 8.1%, 18.3%)in odds of death. Injury severity, mechanism, insurance, and time mediated the effect of male sex, resulting in a 27.3% total increase (95% CI: 21.6%, 10.9%)and a 6.2% direct increase (95% CI: 1.8%, 10.9%)in odds of death. Conclusions: Distance, injury characteristics, and insurance mediate the effects of demographic characteristics on injury mortality and appear to contribute to disparities in injury mortality.
AB - Purpose: Elevated injury mortality rates persist for men and people of color despite attempts to standardize trauma care in the United States. This study investigates the role of injury characteristics and access to trauma care as mediators of the relationships between race, ethnicity, sex, and injury mortality. Methods: Data on prehospital and trauma center care were examined for adult injured patients in Maryland who were transported by emergency medical services to designated trauma centers (n = 15,355)or who died while under emergency medical services care (n = 727). Potential mediators of the relationship between demographic characteristics and injury mortality were identified through exploratory analyses. Total, direct, and indirect effects of race, ethnicity, and sex were estimated using multivariable mediation models. Results: Prehospital time, hospital distance, injury mechanism, and insurance status mediated the effect of African American race, resulting in a 5.7% total increase (95% CI: 1.6%, 9.9%)and 5.6% direct decrease (95% CI: 1.1%, 9.9%)in odds of death. Mechanism, insurance, and distance mediated the effect of Hispanic ethnicity, resulting in an 11.4% total decrease (95% CI: 6.4%, 16.2%)and 13.4% direct decrease (95% CI: 8.1%, 18.3%)in odds of death. Injury severity, mechanism, insurance, and time mediated the effect of male sex, resulting in a 27.3% total increase (95% CI: 21.6%, 10.9%)and a 6.2% direct increase (95% CI: 1.8%, 10.9%)in odds of death. Conclusions: Distance, injury characteristics, and insurance mediate the effects of demographic characteristics on injury mortality and appear to contribute to disparities in injury mortality.
KW - Access to care
KW - Emergency medical services
KW - Health disparities
KW - Injury
KW - Trauma surgery
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U2 - 10.1016/j.annepidem.2019.03.013
DO - 10.1016/j.annepidem.2019.03.013
M3 - Article
C2 - 31053454
AN - SCOPUS:85064942478
SN - 1047-2797
VL - 34
SP - 58-64.e2
JO - Annals of epidemiology
JF - Annals of epidemiology
ER -