Elsevier

Surgery

Volume 148, Issue 2, August 2010, Pages 202-208
Surgery

Society of University Surgeon
Pedestrians struck by motor vehicles further worsen race- and insurance-based disparities in trauma outcomes: The case for inner-city pedestrian injury prevention programs

https://doi.org/10.1016/j.surg.2010.05.010Get rights and content

Background

Pedestrian trauma is the most lethal blunt trauma mechanism, and the rate of mortality in African Americans and Hispanics is twice that compared with whites. Whether insurance status and differential survival contribute to this disparity is unknown.

Methods

This study is a review of vehicle-struck pedestrians in the National Trauma Data Bank, v7.0. Patients <16 years and ≥65 years, as well as patients with Injury Severity Score (ISS) <9, were excluded. Patients were categorized as white, African American, or Hispanic, and as privately insured, government insured, or uninsured. With white and privately insured patients as reference, logistic regression was used to evaluate mortality by race and insurance status after adjusting for patient and injury characteristics.

Results

In all, 26,404 patients met inclusion criteria. On logistic regression, African Americans had 22% greater odds of mortality (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.06–1.41) and Hispanics had 33% greater odds of mortality (OR, 1.33; 95% CI, 1.14–1.54) compared with whites. Uninsured patients had 77% greater odds of mortality (OR, 1.77; 95% CI, 1.52–2.06) compared with privately insured patients.

Conclusion

African American and Hispanic race, as well as uninsured status, increase the risk of mortality after pedestrian crashes. Given the greater incidence of pedestrian crashes in minorities, this compounded burden of injury mandates pedestrian trauma prevention efforts in inner cities to decrease health disparities.

Section snippets

Materials and methods

The National Trauma Data Bank (NTDB) is a national trauma registry that is maintained by the American College of Surgeons and contains more than 1.8 million cases reported from more than 900 participating trauma centers in the United States between 2002 and 2006 (version 7.0).

Patients who were treated for pedestrian injuries were identified by International Classification of Diseases, 9th Revision E codes 810.7 through E819.7. Patients aged less than 16 years were excluded because pediatric

Results

A total of 26,404 patients met inclusion and exclusion criteria and were analyzed in the study (Fig). Of these, 51.1% were white, 25.8% were African American, and 16.6% were Hispanic. Baseline age distributions were similar by race, but Hispanic patients had a greater proportion of male patients (77%; 95% confidence interval [CI], 75.8–78.3%) compared with white (67.8%; 95% CI, 67.0–68.5%) and African American (69.5%; 95% CI, 68.4–70.6%) patients (Table I). Compared with white patients, a

Discussion

African American race, Hispanic race, and uninsured status are independent risk factors for mortality among patients hospitalized after pedestrian trauma. This finding demonstrates that greater mortality rates from pedestrian trauma in racial minorities and the uninsured are not simply caused by greater rates of injury. Minority communities suffer a double burden of injury from pedestrian crashes, because African Americans and Hispanics are both more likely to sustain pedestrian trauma6 and

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