Downwardly mobile

The accidental cost of being uninsured

Heather Rosen, Fady Saleh, Stuart Lipsitz, Selwyn O. Rogers, Atul A. Gawande

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Hypothesis: Given the pervasive evidence of disparities in screening, hospital admission, treatment, and outcomes due to insurance status, a disparity in outcomes in trauma patients (in-hospital death) among the uninsured may exist, despite preventive regulations (such as the Emergency Medical Treatment and Active Labor Act). Design: Data were collected from the National Trauma Data Bank from January 1, 2002, through December 31, 2006 (version 7.0). We used multiple logistic regression to compare mortality rates by insurance status. Setting: The National Trauma Data Bank contains information from 2.7 million patients admitted for traumatic injury to more than 900 US trauma centers, including demographic data, medical history, injury severity, outcomes, and charges. Patients: Data from patients (age,≥18 years; n=687 091) with similar age, race, injury severity, sex, and injury mechanism were evaluated for differences in mortality by payer status. Main Outcome Measure: In-hospital death after blunt or penetrating traumatic injury. Results: Crude analysis revealed a higher mortality for uninsured patients (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.36-1.42; P<.001). Controlling for sex, race, age, Injury Severity Score, Revised Trauma Score, and injury mechanism (adjusted for clustering on hospital), uninsured patients had the highest mortality (OR, 1.80; 95% CI, 1.61-2.02; P<.001). Subgroup analysis of young patients unlikely to have comorbidities revealed higher mortality for uninsured patients (OR, 1.89; 95% CI, 1.66-2.15; P<.001), as did subgroup analyses of patients with head injuries (OR, 1.65; 95% CI, 1.42-1.90; P<.001) and patients with 1 or more comorbidities (OR, 1.52; 95% CI, 1.30-1.78; P<.001). Conclusions: Uninsured Americans have a higher adjusted mortality rate after trauma. Treatment delay, different care (via receipt of fewer diagnostic tests), and decreased health literacy are possible mechanisms.

Original languageEnglish (US)
Pages (from-to)1006-1011
Number of pages6
JournalArchives of Surgery
Volume144
Issue number11
DOIs
StatePublished - Nov 2009
Externally publishedYes

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Costs and Cost Analysis
Wounds and Injuries
Odds Ratio
Confidence Intervals
Mortality
Insurance Coverage
Comorbidity
Databases
Health Literacy
Injury Severity Score
Emergency Treatment
Trauma Centers
Craniocerebral Trauma
Routine Diagnostic Tests
Cluster Analysis
Logistic Models
Demography
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Surgery

Cite this

Rosen, H., Saleh, F., Lipsitz, S., Rogers, S. O., & Gawande, A. A. (2009). Downwardly mobile: The accidental cost of being uninsured. Archives of Surgery, 144(11), 1006-1011. https://doi.org/10.1001/archsurg.2009.195

Downwardly mobile : The accidental cost of being uninsured. / Rosen, Heather; Saleh, Fady; Lipsitz, Stuart; Rogers, Selwyn O.; Gawande, Atul A.

In: Archives of Surgery, Vol. 144, No. 11, 11.2009, p. 1006-1011.

Research output: Contribution to journalArticle

Rosen, H, Saleh, F, Lipsitz, S, Rogers, SO & Gawande, AA 2009, 'Downwardly mobile: The accidental cost of being uninsured', Archives of Surgery, vol. 144, no. 11, pp. 1006-1011. https://doi.org/10.1001/archsurg.2009.195
Rosen H, Saleh F, Lipsitz S, Rogers SO, Gawande AA. Downwardly mobile: The accidental cost of being uninsured. Archives of Surgery. 2009 Nov;144(11):1006-1011. https://doi.org/10.1001/archsurg.2009.195
Rosen, Heather ; Saleh, Fady ; Lipsitz, Stuart ; Rogers, Selwyn O. ; Gawande, Atul A. / Downwardly mobile : The accidental cost of being uninsured. In: Archives of Surgery. 2009 ; Vol. 144, No. 11. pp. 1006-1011.
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