Hospitals Serving More Minorities Have Higher Trauma Death Rate
MONDAY Sept. 19, 2011 -- Regardless of their race or ethnicity, Americans who suffer a traumatic injury face a greater risk of dying at hospitals that serve a high proportion of minority patients, a new study shows.
Strains on hospital funding could be partially to blame, experts say.
"I think a lot of this has to do with the fact that a lot of hospitals with high minority patients are inner-city facilities. So these are places where more patients lack insurance," said study lead author Dr. Adil H. Haider, assistant professor of surgery and director of the Center for Surgery Trials and Outcomes Research at Johns Hopkins School of Medicine in Baltimore. "There's a big financial burden at play here."
The study is published online Sept. 19 in the Archives of Surgery.
Numerous studies have noted poorer outcomes for black and Hispanic patients for illnesses such as cancer or heart disease. But Haider noted that "there has been a long-standing impression that an emergency is the 'great equalizer.'"
According to Haider, that's because "there is near universal access to 9-1-1 [care]," Haider said, "and we don't check race or insurance when we're busy rushing patients into an ER."
Nevertheless, "a lot of research has recently shown that actually there is a difference in traumatic injury outcomes," he said. "And race does make a difference. It's not that it matters if the trauma patient is himself white, black or Hispanic: everybody faces the same outcome. But in a hospital with a high minority population, that outcome will involve a higher rate of death."
In the study, Haider's team analyzed information from the National Trauma Data Bank (NTDB). The investigators looked at records covering nearly 312,000 trauma patients aged 18 to 64 treated at 434 hospitals across the country between 2007 and 2008. The NTDB is home to the largest trauma registry in the country.
Only patients who had suffered an injury severe enough to raise a reasonable risk for death were included.
Hospitals were divided into three categories: those with fewer than 25 percent minority patients; those with between 25 to 50 percent minorities; and those with 50 percent and up.
According to the study, people treated at hospitals with between 25 to 50 percent minority pools faced a 16 to 18 percent higher risk of dying from a traumatic injury (depending on the type of injury), compared to centers where less than one-quarter of all patients were minorities.
And trauma patients treated at hospitals handling even more minority patients -- greater than 50 percent -- faced a 37 to 45 percent higher risk of dying.
These findings held true regardless of the race of the individual patient being treated, the team stressed.
Facilities did tend to differ in key ways. For example, hospitals with the highest minority populations were typically larger, and were more often categorized as level 1 trauma centers (offering the highest level of surgical trauma treatment). Nevertheless, all facilities in the study were roughly equivalent in terms of available surgeons on staff.
But there was one key difference: hospitals with the largest minority populations also had the highest proportion of patients who lacked insurance coverage. And people without insurance coverage did tend to fare worse, regardless of where they were treated.
So, money concerns could be at the heart of the problem Haider said.
"But, what I want to strongly stress is that this is not to say that hospitals that take care of minority patients are bad hospitals," he continued. "It's just that these hospitals have a very, very difficult job to do. And so what we need to do is strengthen these hospitals, so we can improve outcomes."
Dr. Ali Salim, an attending surgeon and program director of the General Surgery Residency Educational Program at Cedars-Sinai Medical Center in Los Angeles, concurred. He described the study as "fascinating and important."
In an editorial accompanying Haider's work, Salim described the problem as a "vicious cycle," where low-performing trauma centers struggle to function in the face of insufficient resources -- a struggle that, in turn, perpetuates continued low performance.
"Hospitals that treat a high proportion of minority populations tend to be treating the 'safety net' population," Salim noted. "So, we need to focus on these kinds of hospitals, and try to improve the resources they have at their disposal. And, in that way, maybe [patient] outcomes as well."
Posted: September 2011