Differences in Injury Characteristics and Outcomes for American Indian/Alaska Native People Hospitalized with Traumatic Injuries: an Analysis of the National Trauma Data Bank

J Racial Ethn Health Disparities. 2019 Apr;6(2):335-344. doi: 10.1007/s40615-018-0529-3. Epub 2018 Oct 1.

Abstract

Objective: This study compares characteristics of American Indian/Alaska Natives (AI/AN) and non-Hispanic Whites (NHW) hospitalized for traumatic injury and examines the effect of race on hospital disposition.

Methods: Using 2007-2014 National Trauma Data Bank data, we described differences in demographic and injury characteristics between AI/AN (n = 39,656) and NHWs (n = 3,309,484) hospitalized with traumatic injuries. Multivariable regressions, adjusted for demographic and injury characteristics, compared in-hospital mortality and the risk of discharge to different dispositions (inpatient rehabilitation/long-term care facility, skilled nursing facility, home with home health services) rather than home between AI/AN and NHW patients.

Results: Compared to NHWs, a higher proportion of AI/ANs were age 19-44 (49% versus 27%) years and hospitalized with assault-related injuries (25% versus 5%). AI/ANs had lower odds of dying than NHWs during hospitalization (adjusted odds ratio (aOR) 0.72, 95% CI 0.63-0.84). However, AI/ANs also had lower odds than NHWs to discharge to locations with additional health services even after controlling for injury severity (inpatient rehabilitation/long-term care facilities aOR 0.79, 95% CI 0.67-0.93; skilled nursing facility aOR 0.70, 95% CI 0.49-0.98; home with home health services aOR 0.62, 95% CI 0.49-0.79).

Conclusions: Injury patterns and acute hospitalization outcomes were significantly different for AI/ANs compared to NHWs. Injury prevention strategies targeting AI/ANs should reflect these differential injury patterns. Outcomes such as disability and access to rehabilitation services should be included when considering the burden of injury among AI/AN communities.

Keywords: Alaska Native; American Indian; Health care disparity; Hospitalization; Rehabilitation; Trauma.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls / statistics & numerical data
  • Accidents, Traffic / statistics & numerical data
  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Alaskan Natives*
  • Child
  • Child, Preschool
  • Databases, Factual
  • European Continental Ancestry Group
  • Female
  • Glasgow Coma Scale
  • Home Care Services
  • Hospital Mortality / ethnology*
  • Hospitalization
  • Humans
  • Indians, North American*
  • Injury Severity Score
  • Insurance, Health / statistics & numerical data
  • Long-Term Care
  • Male
  • Medicaid
  • Medically Uninsured
  • Medicare
  • Middle Aged
  • Multivariate Analysis
  • Patient Discharge / statistics & numerical data
  • Patient Transfer / statistics & numerical data
  • Rehabilitation Centers
  • Skilled Nursing Facilities
  • United States
  • Violence / statistics & numerical data*
  • Wounds and Injuries / ethnology*
  • Wounds and Injuries / etiology
  • Young Adult