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Jan 2012

Association Between Hospitals Caring for a Disproportionately High Percentage of Minority Trauma Patients and Increased Mortality: A Nationwide Analysis of 434 Hospitals

Author Affiliations

Author Affiliations: Center for Surgery Trials and Outcomes Research, Department of Surgery (Drs Haider, Efron, Haut, and Schneider and Ms Scott), and Department of Medicine (Dr Cooper), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Surgery, Howard University College of Medicine, Washington, DC (Drs Ong’uti, Oyetunji, and Cornwell); Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois (Dr Crandall); and Department of Medicine, University of California at San Francisco (Dr Powe).

Arch Surg. 2012;147(1):63-70. doi:10.1001/archsurg.2011.254

Objective To determine whether there is an increased odds of mortality among trauma patients treated at hospitals with higher proportions of minority patients (ie, black and Hispanic patients combined).

Design Hospitals were categorized on the basis of the percentage of minority patients admitted with trauma. The adjusted odds of in-hospital mortality were compared between hospitals with less than 25% of patients who were minorities (the reference group) and hospitals with 25% to 50% of patients who were minorities and hospitals with more than 50% of patients who were minorities. Multivariate logistic regression (with generalized linear modeling and a cluster-correlated robust estimate of variance) was used to control for multiple patient and injury severity characteristics.

Setting A total of 434 hospitals in the National Trauma Data Bank.

Participants Patients aged 18 to 64 years whose medical records were included in the National Trauma Data Bank for the years 2007 and 2008 with an Injury Severity Score of 9 or greater and who were white, black, or Hispanic.

Main Outcome Measures Crude mortality and adjusted odds of in-hospital mortality.

Results A total of 311 568 patients were examined. Hospitals in which the percentage of minority patients was more than 50% also had younger patients, fewer female patients, more patients with penetrating trauma, and the highest crude mortality. After adjustment for potential confounders, patients treated at hospitals in which the percentage of minority patients was 25% to 50% and at hospitals in which the percentage of minority patients was more than 50% demonstrated increased odds of death (adjusted odds ratio, 1.16 [95% confidence interval, 1.01-1.34] and adjusted odds ratio, 1.37 [95% confidence interval, 1.16-1.61], respectively), compared with the reference group. This disparity increased further on subset analysis of patients with a blunt injury. Uninsured patients had significantly increased odds of mortality within all 3 hospital groups.

Conclusions Patients treated at hospitals with higher proportions of minority trauma patients have increased odds of dying, even after adjusting for potential confounders. Differences in outcomes between trauma hospitals may partly explain racial disparities.