Minorities More Likely to Die in ER

MONDAY Oct. 20, 2008 -- Blacks and Hispanics are more likely to die in U.S. emergency rooms after a trauma than white patients are, researchers report.

Moreover, uninsured ER patients are more likely to die compared with insured patients, according to the study in the October issue of the Archives of Surgery.

"Both race and insurance status independently influences survival after trauma," said lead researcher Dr. Adil H. Haider, from the Johns Hopkins School of Medicine, in Baltimore. "Of the two, insurance status appears to have the stronger association with death after trauma."

Compared with an insured white patient, equivalently injured black patients have 20 percent higher risk of dying, while Hispanic patients have a 51 percent increased odds of dying, Haider said.

This problem is even worse for the uninsured, Haider said. "If we look at a similarly injured uninsured white patient, the odds of death go up by 55 percent. For uninsured minorities the odds of death go up even higher -- 78 percent for blacks and 130 percent for Hispanics."

For the study, Haider's team collected data on almost 430,000 patients treated in some 700 trauma centers throughout the United States. Among these patients more than 72,000 were black, almost 42,000 were Hispanic and almost 263,000 were white. In all, 47 percent had health insurance. The data came from the National Trauma Data Bank.

Haider's group found that 8.2 percent of blacks and 9.1 percent of Hispanics died, compared with 5.7 percent of whites. In addition, 8.6 percent of uninsured patients died compared with 4.4 percent of insured patients.

Minorities were much more likely to be uninsured; two-thirds of both black and Hispanic patients in the study were uninsured, while only one-third of white patients had no health insurance. Haider believes lack of health insurance may mean that blacks and Hispanics are less likely to call for an ambulance after being injured. So, by the time they reach the hospital, their condition is more serious than a similarly injured white, insured patient.

Access to trauma care is near universal in the United States, so these dramatic differences in patients with and without insurance are unexpected, Haider said. "The study also shows that there are racial disparities in survival after trauma, and differences in insurance between whites and minorities that cannot explain away these disparities," he said. "Now that we know this, we can go about understanding exactly why these disparities exist and try to come up with solutions."

Dr. Wally Ghurabi, emergency department director at Santa Monica-UCLA Medical Center, believes factors other than insurance and in-hospital care may account for the increased deaths among minority patients.

"This paper raised more questions than answers," Ghurabi said. "One significant component of trauma victim's care is the pre-hospital phase. When an African-American or Hispanic is shot in the [now closed] Martin Luther King Hospital vicinity, transport times are increased -- taking away from that 'golden hour' [of emergency care]. That may be true of other poor communities in the U.S. Whether these patients are insured or not, when you lose minutes in transport you are dealing with a sicker patient," he said.

"I could not get myself to agree with the idea that insurance status determines initial aspect of the care," he said. "But it could be of significance in rehabilitation and whether the patient is compliant or not."

More information

For more on trauma care, visit the American College of Emergency Physicians.

Posted: October 2008


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