Can universal coverage eliminate health disparities? Reversal of disparate injury outcomes in elderly insured minorities

Michelle Ramirez, David C. Chang, Selwyn O. Rogers, Peter T. Yu, Molly Easterlin, Raul Coimbra, Leslie Kobayashi

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Health outcome disparities in racial minorities are well documented. However, it is unknown whether such disparities exist among elderly injured patients. We hypothesized that such disparities might be reduced in the elderly owing to insurance coverage under Medicare. We investigated this issue by comparing the trauma outcomes in young and elderly patients in California. Methods: A retrospective analysis of the California Office of Statewide Health Planning and Development hospital discharge database was performed for all publicly available years from 1995 to 2008. Trauma admissions were identified by International Classification of Disease, Ninth Revision, primary diagnosis codes from 800 to 959, with certain exclusions. Multivariate analysis examined the adjusted risk of in-hospital mortality in young (<65 y) and elderly (≥65 y) patients, controlling for age, gender, injury severity as measured by the survival risk ratio, Charlson comorbidity index, insurance status, calendar year, and teaching hospital status. Results: A total of 1,577,323 trauma patients were identified. Among the young patients, the adjusted odds ratio of death relative to non-Hispanic whites for blacks, Hispanics, Asians, and Native Americans/others was 1.2, 1.2, 0.90, and 0.78, respectively. The corresponding adjusted odds ratios of death for elderly patients were 0.78, 0.87, 0.92, and 0.61. Conclusions: Young black and Hispanic trauma patients had greater mortality risks relative to non-Hispanic white patients. Interestingly, elderly black and Hispanic patients had lower mortality risks compared with non-Hispanic whites.

Original languageEnglish (US)
Pages (from-to)264-269
Number of pages6
JournalJournal of Surgical Research
Volume182
Issue number2
DOIs
StatePublished - Jun 15 2013
Externally publishedYes

Fingerprint

Universal Coverage
Health
Wounds and Injuries
Hispanic Americans
Insurance Coverage
Odds Ratio
Health Planning
Asian Americans
North American Indians
Mortality
International Classification of Diseases
Medicare
Hospital Mortality
Teaching Hospitals
Comorbidity
Multivariate Analysis
Databases

Keywords

  • Elderly
  • Health insurance
  • Minorities
  • Outcomes
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Ramirez, M., Chang, D. C., Rogers, S. O., Yu, P. T., Easterlin, M., Coimbra, R., & Kobayashi, L. (2013). Can universal coverage eliminate health disparities? Reversal of disparate injury outcomes in elderly insured minorities. Journal of Surgical Research, 182(2), 264-269. https://doi.org/10.1016/j.jss.2012.01.032

Can universal coverage eliminate health disparities? Reversal of disparate injury outcomes in elderly insured minorities. / Ramirez, Michelle; Chang, David C.; Rogers, Selwyn O.; Yu, Peter T.; Easterlin, Molly; Coimbra, Raul; Kobayashi, Leslie.

In: Journal of Surgical Research, Vol. 182, No. 2, 15.06.2013, p. 264-269.

Research output: Contribution to journalArticle

Ramirez, Michelle ; Chang, David C. ; Rogers, Selwyn O. ; Yu, Peter T. ; Easterlin, Molly ; Coimbra, Raul ; Kobayashi, Leslie. / Can universal coverage eliminate health disparities? Reversal of disparate injury outcomes in elderly insured minorities. In: Journal of Surgical Research. 2013 ; Vol. 182, No. 2. pp. 264-269.
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