LAKE BUENA VISTA, FLA. — Trauma patients treated at trauma safety net hospitals—those that care for the highest percentage of uninsured patients—have equivalent in-hospital mortality as trauma patients treated at non-trauma safety net hospitals—those that care for a predominantly insured clientele.
In a retrospective analysis of trauma patients aged 18–64 years included in the National Trauma Data Bank for the years 2001–2005, the adjusted odds ratio of death was 0.93 (95% confidence interval, 0.65–1.32) for both types of facilities.
The result indicates that disparate trauma outcomes because of insurance status are not explained by differences between treating institutions, Dr. Anit S. Vettukattil of Georgetown University Hospital, Washington, said at the annual meeting of the Eastern Association for the Surgery of Trauma.
Trauma safety net hospitals were defined as facilities whose patient population was at least 47% uninsured trauma patients; non-trauma safety net hospitals were facilities with less than 47% uninsured trauma patients. Only adults between the ages of 18 and 64 years with moderate to severe injuries were included. The study adjusted for differences in patients' age, sex, insurance status, injury severity, severe head injury, hypotension upon arrival in the emergency department, and type and mechanism of injury.
A variety of subset analyses also were performed to rule out any possible confounding effect of different trauma center types. These analyses focused on university teaching hospitals, public hospitals, and level 1 trauma centers, Dr. Vettukattil said.
The analysis looked at 36,774 patients treated at 46 trauma safety net hospitals, and 306,279 patients treated at 413 non-trauma safety net hospitals. A mean of 61% of patients were uninsured at the trauma safety net hospitals, and a mean of 26% of patients were uninsured at the non-trauma safety net hospitals.
The majority of patients at both types of hospital were male (78% at trauma safety net vs. 73% at non-trauma safety net hospitals), and the mean ages were also similar (36 years at trauma safety net vs. 38 years at non-trauma safety net hospitals). However, 55% of the patients treated at safety net hospitals were black or Hispanic, compared with 27% of patients treated at non-safety net hospitals.
The unadjusted mortality rate was greater in trauma safety net hospitals, compared with non-trauma safety net hospitals (6.8% vs. 4.6%, P less than .05). However, after controlling for patient and hospital type, patients at both kinds of facility had the same odds ratio of death of 9.3.
Patients treated at hospitals that care for the highest percentage of uninsured patients have been shown to be at risk for worse outcomes. These results show, however, that such disparities are not because of the care these patients receive at safety net hospitals, coauthor Dr. Adil H. Haider said in an interview.
“We were very careful in doing our analysis. Our results were very consistent. Every time we analyzed the data, we got the same result. There is no difference in mortality between safety net and non-safety net hospitals. The fact that this stood up to every single statistical test we could think of makes us very confident in concluding that the disparities in outcome between insured and uninsured patients is not explained by differences between the treating institutions,” said Dr. Haider, who is codirector of the Trauma Outcomes Research Group at Johns Hopkins University, Baltimore.
He added that trauma safety net hospitals must be supported. “These centers are providing excellent care. If they are to close because of financial troubles, we will really be disenfranchising a tremendous number of patients.”
Neither Dr. Vettukattil nor Dr. Haider disclosed any conflicts of interest.
Disparate trauma outcomes due to insurance status are not explained by differences between treating institutions. DR. VETTUKATTIL
'Our results were very consistent. Every time we analyzed the data, we got the same result.' Dr. Haider