Trends in racial disparities for injured patients admitted to trauma centers

Abstract

Objective: To determine whether outcome disparities between black and white trauma patients have decreased over the last 10 years.

Data source: Pennsylvania Trauma Outcome Study.

Study design: We performed an observational cohort study on 191,887 patients admitted to 28 Level 1 and Level II trauma centers. The main outcomes of interest were (1) death, (2) death or major complication, and (3) failure-to-rescue. Hospitals were categorized according to the proportion of black patients. Multivariate regression models were used to estimate trends in racial disparities and to assess whether the source of racial disparities was within or between hospitals.

Principal findings: Trauma patients admitted to hospitals with high concentrations of blacks (>20 percent) had a 45 percent higher odds of death (adj OR: 1.45, 95 percent CI: 1.09-1.92) and a 73 percent higher odds of death or major complication (adj OR: 1.73, 95 percent CI: 1.42-2.11) compared with patients admitted to hospitals treating low proportions of blacks. Blacks and whites admitted to the same hospitals had no difference in mortality (adj OR: 1.05, 95 percent CI: 0.87, 1.27) or death or major complications (adj OR: 1.01; 95 percent CI: 0.90, 1.13). The odds of overall mortality, and death or major complications have been reduced by 32 percent (adj OR: 0.68; 95 percent CI: 0.54-0.86) and 28 percent (adj OR: 0.72; 95 percent CI: 0.60-0.85) between 2000 and 2009, respectively. Racial disparities did not change over 10 years.

Conclusion: Despite the overall improvement in outcomes, the gap in quality of care between black and white trauma patients in Pennsylvania has not narrowed over the last 10 years. Racial disparities in trauma are due to the fact that black patients are more likely to be treated in lower quality hospitals compared with whites.

Keywords: Race; disparities; trauma.

Figure 1

Distribution of Black Trauma Patients and Hospital Proportion of Poorly Insured Trauma Patients as a Function of the Hospital Proportion of Black Patients

Figure 2

Outcomes as a Function of Hospital Concentration of Black Patients, after Adjusting for Age, Sex, Transfer Status, Injury Severity, Mechanism of Injury, Motor Component of Glasgow Coma Scale, Systolic Blood Pressure, Comorbidities, and Year of Admission

Figure 3

(a) Hospital Quality, Based on Death or Major Complications, as a Function of the Minority Patient Population. Each trauma center is represented by a separate point. (b) Hospital Quality, Based on Death or Major Complications, as a Function of the Minority Patient Population. Error bars represent 95 percent confidence intervals. Each trauma center is represented by a separate point

Figure 4

(a) Adjusted Mortality Rate for Black versus White Patients between 2000 and 2009. (The gap between blacks and whites did not change over time [p = .902]. Vertical bars represent 95 percent confidence intervals.) (b) Adjusted Death or Major Complication Rate for Black versus White Patients between 2000 and 2009. (The gap between blacks and whites increases slightly over time [adj OR 1.03; 95 percent CI: 1.00–1.05; p = .05]. Vertical bars represent 95 percent confidence intervals)