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Minority Trauma Patients Tend to Cluster at Trauma Centers with Worse-than-Expected Mortality: Can This Phenomenon Help Explain Racial Disparities in Trauma Outcomes?
Adil H Haider*1, Zain G. Hashmi*1, Syed Nabeel Zafar*2, Xuan Hui*1, Eric B Schneider*1, David T Efron*1, Elliott R Haut*1, Lisa A Cooper*3, Ellen MacKenzie*3, Edward E Cornwell, III2
1Johns Hopkins School of Medicine, Baltimore, MD;2Howard University College of Medicine, Washington, DC;3Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

OBJECTIVE(S):Racial disparities in survival after traumatic injury have been described. However, the mechanisms that lead to these inequities are not well understood. Minority patients have been shown to cluster at hospitals that display financial challenges. Our objective was to determine if minority trauma patients are more commonly treated at trauma centers (TCs) that have poor observed versus expected survival. METHODS:Analysis of Level 1 and 2 TCs included in the National Trauma Data Bank 2007-2010. Patients ≥16 years, with Injury Severity Score ≥9 included. TC’s with > 50% Hispanic or Black patients classified as predominantly-minority TCs. Multivariate logistic regression adjusting for several patient/injury characteristics was used to predict the expected number of deaths for each TC. Observed-to-expected (O/E) mortality ratios were then generated and used to rank individual TCs as low (O/E <1), average or high mortality (O/E>1).
RESULTS:620,797 patients from 189 TCs were analyzed; 89(47.1%) TCs were found to be high mortality, 13(6.9%) average and 87(46.0%) low mortality. More of the predominantly-minority TCs {(77%(23/30) versus 42%(66/159)}were high mortality (p<0.001). Approximately 62%(55,848/90,251) of Black patients were treated at high mortality TCs compared to 51%(31,347/60,990) Hispanics and 39%(167,145/429,029) Whites(p<0.001). Subset analysis on blunt trauma patients only yielded similar results. CONCLUSIONS:Minority trauma patients are clustered at hospitals with significantly higher-than-expected mortality. Differential mortality outcomes between centers may partly explain trauma outcomes disparities.



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