December 12, 2011
Trauma patients more likely to die at hospitals serving minorities
Patients’ lack of insurance likely impacting quality of care, mortality, study finds
Seriously injured patients cared for at hospitals serving larger numbers of minorities are significantly more likely to die than those treated at hospitals serving mostly whites, regardless of the race of the patient, new Johns Hopkins research suggests.
The racial makeup of the general patient population in a trauma care facility may be a major factor contributing to the well-documented problem of racial disparities in treatment outcomes experienced by trauma patients in the United States, the researchers argue in the September issue of Archives of Surgery.
Study leader Adil H. Haider, an assistant professor of surgery at the Johns Hopkins University School of Medicine, says that the root cause could be financial. The low-performing hospitals—those with a higher death rate among trauma victims—generally serve a higher proportion of uninsured and low-income patients, meaning the facilities may have less money to devote to patient care.
“This study shows us that we need to strengthen the resources of hospitals that serve large numbers of minority and uninsured patients,” said Haider, a trauma surgeon. “The higher the number of uninsured patients, the less able the hospital may be to improve care and outcomes.”
Haider and his team examined records from 311,568 adult trauma patients treated for serious injuries at 434 U.S. hospitals in 2007 and 2008.
The researchers placed hospitals into one of three categories: those in which the percentage of minority patients is more than 50 percent, those in which the percentage of white patients is more than 50 percent and those in which 25 to 50 percent of patients are minorities.
More than 50 percent of the hospitals were predominantly white, more than a quarter were mixed, and 13 percent were classified as predominantly minority.
Trauma patients at mixed hospitals were 16 percent more likely to die than those at mostly white hospitals, and patients at predominantly minority hospitals were 37 percent more likely to die, the researchers found. In analyzing only patients with blunt injuries, such as those from a car crash, patients at predominantly minority hospitals were even more likely to die (45 percent).
Insurance status also differed at these hospitals. Trauma patients treated at the predominantly white hospitals were nearly twice as likely to have insurance as those taken to predominantly minority hospitals. People without insurance tend to visit doctors less often and may arrive at the hospital with more pre-existing health problems that complicate their serious traumas, problems that could impact recovery, Haider says.
“Lack of insurance is generally regarded as more than just the inability to pay a bill,” added Haider, who is also co-director of the Johns Hopkins Center for Surgery Trials and Outcomes Research. Hospitals that treat more minorities and more uninsured often have issues such as staffing shortages, constrained budgets and lack of capital and technical support, he says.
Another important finding of the new study, Haider notes, is that minority patients did not have worse outcomes at predominantly white hospitals. He says this suggests that a large proportion of racial disparities observed after trauma may be due to worse outcomes seen at predominantly minority hospitals.
“The heavy concentration of minority patients at a relatively small number of hospitals presents a unique opportunity for interventions that could achieve an immediate and substantial impact in mitigating disparities,” Haider said. “If we focus on hospitals that predominantly serve minority populations, we may be able to get an excellent bang for our buck.”
This study was supported by grants from the National Institutes of Health, the American College of Surgeons and the Johns Hopkins Center for Health Disparities Solutions.
Other Johns Hopkins researchers working on this study are David T. Efron, Valerie K. Scott, Elliott R. Haut, Eric B. Schneider and Lisa A. Cooper.