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Incarceration is associated with higher mortality after trauma: An unreported health care disparity
Harry Newman-Plotnick1, James P Byrne, Elliott Richard Haut
1From the Division of Plastic and Reconstructive Surgery, Department of Surgery (H.N.-P.), Albany Medical Center, Albany, New York; Johns Hopkins Bloomberg School of Public Health (H.N.-P., E.R.H.); Division of Acute Care Surgery, Department of Surgery (J.P.B., E.R.H.), Johns Hopkins Medicine, Baltimore, Maryland; Division of General Surgery, Department of Surgery (J.P.B.), University of British Columbia, Vancouver, British Columbia, Canada; and Department of Plastic and Reconstructive Surgery (C.S.H.), WakeMed Health and Hospitals, Raleigh, North Carolina.
Background:
While the United States has the highest incarceration rate worldwide, at nearly 1% of the adult population (more than 2 million people), insights regarding health disparities in this population remain limited. This retrospective cohort study represents the largest national database analysis of incarcerated trauma patients to date and investigates whether incarceration status is an independent risk factor for poor outcomes after trauma for US adults.
Methods:
We analyzed data from the National Trauma Data Bank from 2017 to 2018. Using multilevel logistic regression, we measured risk-adjusted associations between incarceration status (assessed by International Classification of Diseases, Tenth Revision , location codes) and trauma outcomes: mortality, any in-hospital complications, aggregate major complications, and failure to rescue. We report odds ratios and 95% confidence intervals, adjusting for demographics, transfer status, insurance, comorbidities, injury mechanism, injury severity, and presenting vitals. A secondary analysis was performed using nearest neighbor matching with a 2:1 ratio of nonincarcerated to incarcerated patients, followed by multilevel logistic regression.
Results:
There were 12,888 incarcerated patients and 1,654,254 nonincarcerated patients. Incarcerated patients were younger (median, 36 vs. 55 years), more likely to be male (94.9% vs. 60.5%), Black (27.9% vs. 13.9%), and Hispanic (15.7% vs. 11.5%) and presented more frequently with minor injuries (Injury Severity Score, <9; 65.4% vs. 48.9%) and with stabbings and other blunt events as mechanisms of injury. Although unadjusted mortality was lower for incarcerated patients, after adjustment, they were significantly more likely to die (adjusted odds ratio (AOR), 1.42 [1.19-1.68]), which was consistent in the matched analysis (AOR, 1.19 [1.03-1.36]). Incarcerated patients were, conversely, less likely to suffer any in-hospital complication (AOR, 0.76 [0.68-0.85]; matched AOR, 0.88 [0.81-0.97]).
Conclusion:
Our study redemonstrated that incarcerated trauma patients' demographics and injuries differ significantly from nonincarcerated patients. Furthermore, incarceration was an independent risk factor for mortality, a previously unreported disparity. This highlights the need for improved data collection regarding incarceration status and national prospective investigations.
Level Of Evidence:
Prognostic and Epidemiological; Level III.
