Insurance status, mortality, and hospital use among pediatric trauma patients over three decades
Chistopher R Reed1, Mark E Hamill2, Shawn D Safford2
1Duke University Medical Center, 2301 Erwin Road, Durham, NC 27710, United States.
Insights
Lack of health insurance increases mortality risk in pediatric trauma patients. Despite this, uninsured children experienced shorter hospital stays and less intensive care unit (ICU) use.
Area of Science:
- Pediatric Trauma Care
- Health Services Research
- Public Health
Background:
- Investigating the impact of insurance status on outcomes for pediatric trauma patients.
- Examining associations with mortality, resource utilization, and comorbidities.
Purpose of the Study:
- To determine the relationship between lack of insurance and adverse outcomes in pediatric trauma.
- To analyze trends in mortality and resource use over time based on insurance status.
Main Methods:
- Analysis of a trauma database including 3120 pediatric patients (1989-2013).
- Data included demographics, Injury Severity Score (ISS), insurance status, comorbidities, hospital and ICU length of stay (LOS), and mortality.
- Logistic regression and tests of equivalence were employed for statistical analysis.
Main Results:
- Uninsured pediatric trauma patients had a significantly higher mortality rate (8.4%) compared to insured patients (3.6%).
- This association remained significant after multivariable adjustment (OR=2.83).
- Uninsured patients had decreased hospital and ICU lengths of stay (LOS), but no correlation with medical comorbidities was found.
Conclusions:
- Lack of insurance is a significant predictor of mortality in pediatric trauma, independent of comorbidities.
- The disparity in mortality persisted over time, despite an overall decrease in pediatric trauma mortality.
- Interestingly, lack of insurance was associated with reduced hospital and ICU utilization.
Background:
We investigated the association between lack of insurance and mortality, resource use, and medical comorbidities among pediatric trauma patients.
Methods:
Our trauma database was queried for patients <18 years old from 1989 through 2013. Data collected included demographics, injury severity score (ISS), and insurance status. Dependent variables included major medical comorbidities, hospital and ICU lengths of stay (LOS), and mortality. Logistic regression and tests of equivalence were used to analyze the data.
Results:
A total of 3120 patients were included. The mortality among patients with insurance was 3.6% compared to 8.4% among those without insurance (p=0.0001, OR =2.42, 95% CI=1.53-3.82). This relationship remained statistically significant with adjustment via multivariable logistic regression (p=0.0001, OR =2.83, 95% CI: 1.64-4.74). Hospital and ICU LOS were significantly greater among insured patients in severely and moderately injured samples, respectively. There was no correlation between insurance and medical comorbidities. The uninsured mortality rate was 12.9% from 1989 to 1997 compared to 3.9% in 2006-2013.
Conclusion:
Lack of insurance was associated with mortality but not preexisting comorbidity. This relationship persisted over time despite an overall decline in mortality. Additionally, lack of insurance was associated with decreased hospital stay and ICU utilization.
Level Of Evidence:
Treatment Study, Level III.
