Disparities in Trauma Care for Latino Patients: An Analysis by Trauma Center Verification Level

Gabriel Scally; Jesus Orozco; Eva Tovar Hirashima; Nicholas W Sheets

doi:10.7759/cureus.76282

Disparities in Trauma Care for Latino Patients: An Analysis by Trauma Center Verification Level

Cureus. 2024 Dec 23;16(12):e76282. doi: 10.7759/cureus.76282. eCollection 2024 Dec.

Authors

Gabriel Scally¹, Jesus Orozco², Eva Tovar Hirashima³, Nicholas W Sheets⁴

Affiliations

¹ General Surgery, HCA Healthcare Riverside, Riverside, USA.
² School of Medicine, University of California Riverside School of Medicine, Riverside, USA.
³ Emergency Medicine, Riverside Community Hospital, Riverside, USA.
⁴ Trauma and Acute Care Surgery, Riverside Community Hospital, Riverside, USA.

Abstract

Introduction Trauma is the leading cause of death for individuals under 45 in the United States (US), with significant disparities in outcomes among minority groups. Latinos, the largest ethnic minority in the US, often face barriers to optimal trauma care that may require additional resources. This study aimed to compare trauma outcomes for Latino patients treated at Level I versus Level II/III trauma centers (TCs). Methods We conducted a retrospective analysis using the National Trauma Data Bank (NTDB) from 2019 to 2021. Latino patients aged ≥ 18 years treated at Level I and Level II/III TCs were included. The primary outcome was in-hospital mortality, while secondary outcomes included length of stay (LOS), intensive care unit (ICU) LOS, ventilator days, in-hospital complications, and discharge disposition. Propensity score matching was used to control for age, sex, injury severity, and mechanism of injury. Statistical analyses were performed with a significance level of P < 0.05. Results The unmatched cohort included 221,050 Latino patients, with 139,286 treated at Level I and 81,764 at Level II/III TCs. After matching, 81,764 patients remained in each group. Level I TCs had lower mortality (1.26% vs. 1.48%; P < 0.05) and higher discharge-to-home rates (75.22% vs. 73.15%; P < 0.05) yet had longer hospital LOS (6.53 ± 0.03 vs. 6.17 ± 0.03; P < 0.05), ICU LOS (5.56 ± 0.05 vs. 5.13 ± 0.04; P < 0.05), and more in-hospital complications (3.92% vs. 3.67%; P < 0.05). Conclusion Despite similar baseline characteristics, Latino patients treated at Level I TCs had better survival and disposition outcomes but experienced longer LOS and higher complication rates. While resource availability largely determines trauma verification level and may be responsible for disparities in care, more studies are needed to investigate further how verification level impacts care for Latino patients.

Keywords: acute care surgery and trauma; acute trauma care; latino communties; national trauma data bank; racial disparity.