Minority trauma patients tend to cluster at trauma centers with worse-than-expected mortality can this phenomenon help explain racial disparities in trauma outcomes?

Adil H. Haider, Zain G. Hashmi, Syed Nabeel Zafar, Xuan Hui, Eric B. Schneider, David T. Efron, Elliott R. Haut, Lisa A. Cooper, Ellen J. MacKenzie, Edward E. Cornwell

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To determine whether minority trauma patients are more commonly treated at trauma centers (TCs) with worse observed-to-expected (O/E) survival. Background: Racial disparities in survival after traumatic injury have been described. However, the mechanisms that lead to these inequities are not well understood. Methods: Analysis of level I/II TCs included in the National Trauma Data Bank 2007-2010. White, Black, and Hispanic patients 16 years or older sustaining blunt/penetrating injuries with an Injury Severity Score of 9 or more were included. TCs with 50% or more Hispanic or Black patients were classified as predominantly minority TCs. Multivariate logistic regression adjusting for several patient/injury characteristics was used to predict the expected number of deaths for each TC.O/E mortality ratioswere then generated and used to rank individualTCs as low(O/E<1), intermediate, or high mortality (O/E>1). Results: A total of 556,720 patients from 181 TCs were analyzed; 86 TCs (48%) were classified as low mortality, 6 (3%) intermediate, and 89 (49%) as high mortality. More of the predominantly minority TCs [(82% (22/27) vs 44% (67/154)] were classified as high mortality (P < 0.001). Approximately 64% of Black patients (55,673/87,575) were treated at high-mortality TCs compared with 54% Hispanics (32,677/60,761) and 41% Whites (165,494/408,384) (P < 0.001). Conclusions: Minority trauma patients are clustered at hospitals with significantly higher-than-expected mortality. Black and Hispanic patients treated at low-mortality hospitals have a significantly lower odds of death than similar patients treated at high-mortality hospitals. Differences in TC outcomes and quality of care may partially explain trauma outcomes disparities.

Original languageEnglish (US)
Pages (from-to)572-579
Number of pages8
JournalAnnals of surgery
Volume258
Issue number4
DOIs
StatePublished - Oct 2013

Keywords

  • Benchmarking
  • Disparities
  • Outcomes
  • Quality
  • Trauma

ASJC Scopus subject areas

  • Surgery

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