Not Just an Urban Phenomenon: Uninsured Rural Trauma Patients at Increased Risk for Mortality

Azeemuddin Ahmed; Karisa K Harland; Bryce Hoffman; Junlin Liao; Kent Choi; Dionne Skeete; Gerene Denning

doi:10.5811/westjem.2015.7.27351

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Not Just an Urban Phenomenon: Uninsured Rural Trauma Patients at Increased Risk for Mortality

Journal article

Open access

Peer reviewed

Not Just an Urban Phenomenon: Uninsured Rural Trauma Patients at Increased Risk for Mortality

Azeemuddin Ahmed, Karisa K Harland, Bryce Hoffman, Junlin Liao, Kent Choi, Dionne Skeete and Gerene Denning

The western journal of emergency medicine, Vol.16(5), pp.632-641

09/2015

DOI: 10.5811/westjem.2015.7.27351

PMCID: PMC4644028

PMID: 26587084

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Abstract

Introduction: National studies of largely urban populations showed increased risk of traumatic death among uninsured patients, as compared to those insured. No similar studies have been done for major trauma centers serving rural states. Methods: We performed retrospective analyses using trauma registry records from adult, non-burn patients admitted to a single American College of Surgeons-certified Level 1 trauma center in a rural state (2003-2010, n=13,680) and National Trauma Data Bank (NTDB) registry records (2002-2008, n=380,182). Risk of traumatic death was estimated using multivariable logistic regression analysis. Results: We found that 9% of trauma center patients and 27% of NTDB patients were uninsured. Overall mortality was similar for both (~4.5%). After controlling for covariates, uninsured trauma center patients were almost five times more likely to die and uninsured NTDB patients were 75% more likely to die than commercially insured patients. The risk of death among Medicaid patients was not significantly different from the commercially insured for either dataset. Conclusion: Our results suggest that even with an inclusive statewide trauma system and an emergency department that does not triage by payer status, uninsured patients presenting to the trauma center were at increased risk of traumatic death relative to patients with commercial

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Details

Title: Subtitle: Not Just an Urban Phenomenon: Uninsured Rural Trauma Patients at Increased Risk for Mortality
Creators: Azeemuddin Ahmed - University of Iowa, Department of Emergency Medicine, Iowa City, Iowa
Karisa K Harland - University of Iowa, Department of Emergency Medicine, Iowa City, Iowa
Bryce Hoffman - University of Iowa, Department of Emergency Medicine, Iowa City, Iowa
Junlin Liao - University of Iowa, Department of Surgery, Iowa City, Iowa
Kent Choi - University of Iowa, Department of Surgery, Iowa City, Iowa
Dionne Skeete - University of Iowa, Department of Surgery, Iowa City, Iowa
Gerene Denning - University of Iowa, Department of Emergency Medicine, Iowa City, Iowa
Resource Type: Journal article
Publication Details: The western journal of emergency medicine, Vol.16(5), pp.632-641
DOI: 10.5811/westjem.2015.7.27351
PMID: 26587084
PMCID: PMC4644028
NLM abbreviation: West J Emerg Med
ISSN: 1936-900X
eISSN: 1936-9018
Publisher: Department of Emergency Medicine, University of California, Irvine School of Medicine
Language: English
Date published: 09/2015
Academic Unit: Management and Entrepreneurship ; Epidemiology; Emergency Medicine; Surgery; Injury Prevention Research Center; Public Policy Center (Archive); Law Faculty
Record Identifier: 9984024510702771

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