Lower Extremity Penetrating Trauma Care Associated With Race and Income in the United States of America

For lower extremity penetrating traumas (LEPT), the impact of race and insurance status, as a surrogate of socioeconomic status, is still not fully elucidated. This study aims to explore the relationship between these variables and the likelihood of receiving an amputation for LEPT to further identify disparities in trauma care.

We analyzed the 2017-2019 Trauma Quality Improvement Program databases to identify patients with LEPT. Univariate analysis of various patient factors was performed for mortality. Linear and logistic multivariate regressions were then conducted for the primary and secondary outcomes using significant variables from the univariate analysis. Finally, multivariate logistic regression identified associations between race, ethnicity, primary payor, and amputation rates.

The independent factors significantly linked to amputation included Black race (odds ratio (OR) 0.745, P < 0.001), Medicare (OR 0.557, P < 0.001), Medicaid (OR 0.697, P < 0.001), and uninsured status (OR 0.661, P < 0.001). We additionally evaluated the incidence of death among the penetrating trauma victims and determined that male (OR 2.008, P < 0.001), Black (OR 1.801, P = 0.001), and uninsured patients (OR 1.910, P = 0.003) were more likely to die during admission than the privately insured.

Compared to privately insured victims, uninsured patients and those on Medicaid and Medicare experience lower amputation rates post-LEPT. Black patients were found to have not only a decreased likelihood of receiving an amputation following LEPT but also an increased rate of mortality during admission compared to Caucasian victims. These findings underscore the urgency to address institutional barriers hindering vulnerable populations from accessing appropriate care after trauma.