Insurance Type is a Determinant of 2-Year Mortality After Non-neurologic Trauma

Ben L. Zarzaur, Brad R. Stair, Louis J. Magnotti, Martin Croce, Timothy Fabian

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Lack of health insurance (NO-INS) is associated with increased long-term mortality after head and spinal cord injuries (NEURO-TRA). Less is known about the influence of insurance type and long-term mortality following non-NEURO-TRA. We hypothesized that NO-INS would be associated with 2-y mortality after moderate to severe injury. Methods: Adults (≥18) treated at a level-I trauma center following a moderate to severe blunt injury (ISS>15) and without NEURO-TRA from 2000-2005 and discharged alive were eligible for the study. Two-y mortality was determined utilizing the Social Security Administration Death Master File. Logistic regression analysis was used to determine if type of insurance [NO-INS, Private (PRIV-INS), Medicare/Medicaid; GOV-INS), or Other (OTH-INS)] was related to 2-y mortality. Results: One thousand nine hundred fifty-eight patients met study inclusion/exclusion criteria. Two-y risk of death was 2.96%. On univariate analysis, admission age, lactate, and insurance type were associated with 2-y mortality (P<0.25). However, race was not. After adjusting for admission age and lactate, compared with PRIV-INS, having either NO-INS or GOV-INS was significantly associated with increased 2-y mortality. The analysis was repeated without patients eligible for Medicare (Age ≥ 65), and GOV-INS was still associated with increased 2-y mortality (OR 4.47 P<0.05). Conclusion: Following moderate to severe blunt, non-NEURO-TRA, having GOVT-INS or NO-INS was associated with increased 2-y mortality. The mechanism by which this association may be explained is unclear. Future research focused on elucidating mechanisms behind poor long-term outcomes should include an examination of socioeconomic status as a potential contributor to reduced long-term mortality after injury.

Original languageEnglish (US)
Pages (from-to)196-201
Number of pages6
JournalJournal of Surgical Research
Volume160
Issue number2
DOIs
StatePublished - May 15 2010

Fingerprint

Insurance
Mortality
Wounds and Injuries
Medicare
Lactic Acid
United States Social Security Administration
Nonpenetrating Wounds
Trauma Centers
Medicaid
Health Insurance
Spinal Cord Injuries
Social Class
Logistic Models
Head
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Insurance Type is a Determinant of 2-Year Mortality After Non-neurologic Trauma. / Zarzaur, Ben L.; Stair, Brad R.; Magnotti, Louis J.; Croce, Martin; Fabian, Timothy.

In: Journal of Surgical Research, Vol. 160, No. 2, 15.05.2010, p. 196-201.

Research output: Contribution to journalArticle

Zarzaur, Ben L. ; Stair, Brad R. ; Magnotti, Louis J. ; Croce, Martin ; Fabian, Timothy. / Insurance Type is a Determinant of 2-Year Mortality After Non-neurologic Trauma. In: Journal of Surgical Research. 2010 ; Vol. 160, No. 2. pp. 196-201.
@article{38a31a3525b94deca806b3cdd581f50d,
title = "Insurance Type is a Determinant of 2-Year Mortality After Non-neurologic Trauma",
abstract = "Background: Lack of health insurance (NO-INS) is associated with increased long-term mortality after head and spinal cord injuries (NEURO-TRA). Less is known about the influence of insurance type and long-term mortality following non-NEURO-TRA. We hypothesized that NO-INS would be associated with 2-y mortality after moderate to severe injury. Methods: Adults (≥18) treated at a level-I trauma center following a moderate to severe blunt injury (ISS>15) and without NEURO-TRA from 2000-2005 and discharged alive were eligible for the study. Two-y mortality was determined utilizing the Social Security Administration Death Master File. Logistic regression analysis was used to determine if type of insurance [NO-INS, Private (PRIV-INS), Medicare/Medicaid; GOV-INS), or Other (OTH-INS)] was related to 2-y mortality. Results: One thousand nine hundred fifty-eight patients met study inclusion/exclusion criteria. Two-y risk of death was 2.96{\%}. On univariate analysis, admission age, lactate, and insurance type were associated with 2-y mortality (P<0.25). However, race was not. After adjusting for admission age and lactate, compared with PRIV-INS, having either NO-INS or GOV-INS was significantly associated with increased 2-y mortality. The analysis was repeated without patients eligible for Medicare (Age ≥ 65), and GOV-INS was still associated with increased 2-y mortality (OR 4.47 P<0.05). Conclusion: Following moderate to severe blunt, non-NEURO-TRA, having GOVT-INS or NO-INS was associated with increased 2-y mortality. The mechanism by which this association may be explained is unclear. Future research focused on elucidating mechanisms behind poor long-term outcomes should include an examination of socioeconomic status as a potential contributor to reduced long-term mortality after injury.",
author = "Zarzaur, {Ben L.} and Stair, {Brad R.} and Magnotti, {Louis J.} and Martin Croce and Timothy Fabian",
year = "2010",
month = "5",
day = "15",
doi = "10.1016/j.jss.2009.06.059",
language = "English (US)",
volume = "160",
pages = "196--201",
journal = "Journal of Surgical Research",
issn = "0022-4804",
publisher = "Academic Press Inc.",
number = "2",

}

TY - JOUR

T1 - Insurance Type is a Determinant of 2-Year Mortality After Non-neurologic Trauma

AU - Zarzaur, Ben L.

AU - Stair, Brad R.

AU - Magnotti, Louis J.

AU - Croce, Martin

AU - Fabian, Timothy

PY - 2010/5/15

Y1 - 2010/5/15

N2 - Background: Lack of health insurance (NO-INS) is associated with increased long-term mortality after head and spinal cord injuries (NEURO-TRA). Less is known about the influence of insurance type and long-term mortality following non-NEURO-TRA. We hypothesized that NO-INS would be associated with 2-y mortality after moderate to severe injury. Methods: Adults (≥18) treated at a level-I trauma center following a moderate to severe blunt injury (ISS>15) and without NEURO-TRA from 2000-2005 and discharged alive were eligible for the study. Two-y mortality was determined utilizing the Social Security Administration Death Master File. Logistic regression analysis was used to determine if type of insurance [NO-INS, Private (PRIV-INS), Medicare/Medicaid; GOV-INS), or Other (OTH-INS)] was related to 2-y mortality. Results: One thousand nine hundred fifty-eight patients met study inclusion/exclusion criteria. Two-y risk of death was 2.96%. On univariate analysis, admission age, lactate, and insurance type were associated with 2-y mortality (P<0.25). However, race was not. After adjusting for admission age and lactate, compared with PRIV-INS, having either NO-INS or GOV-INS was significantly associated with increased 2-y mortality. The analysis was repeated without patients eligible for Medicare (Age ≥ 65), and GOV-INS was still associated with increased 2-y mortality (OR 4.47 P<0.05). Conclusion: Following moderate to severe blunt, non-NEURO-TRA, having GOVT-INS or NO-INS was associated with increased 2-y mortality. The mechanism by which this association may be explained is unclear. Future research focused on elucidating mechanisms behind poor long-term outcomes should include an examination of socioeconomic status as a potential contributor to reduced long-term mortality after injury.

AB - Background: Lack of health insurance (NO-INS) is associated with increased long-term mortality after head and spinal cord injuries (NEURO-TRA). Less is known about the influence of insurance type and long-term mortality following non-NEURO-TRA. We hypothesized that NO-INS would be associated with 2-y mortality after moderate to severe injury. Methods: Adults (≥18) treated at a level-I trauma center following a moderate to severe blunt injury (ISS>15) and without NEURO-TRA from 2000-2005 and discharged alive were eligible for the study. Two-y mortality was determined utilizing the Social Security Administration Death Master File. Logistic regression analysis was used to determine if type of insurance [NO-INS, Private (PRIV-INS), Medicare/Medicaid; GOV-INS), or Other (OTH-INS)] was related to 2-y mortality. Results: One thousand nine hundred fifty-eight patients met study inclusion/exclusion criteria. Two-y risk of death was 2.96%. On univariate analysis, admission age, lactate, and insurance type were associated with 2-y mortality (P<0.25). However, race was not. After adjusting for admission age and lactate, compared with PRIV-INS, having either NO-INS or GOV-INS was significantly associated with increased 2-y mortality. The analysis was repeated without patients eligible for Medicare (Age ≥ 65), and GOV-INS was still associated with increased 2-y mortality (OR 4.47 P<0.05). Conclusion: Following moderate to severe blunt, non-NEURO-TRA, having GOVT-INS or NO-INS was associated with increased 2-y mortality. The mechanism by which this association may be explained is unclear. Future research focused on elucidating mechanisms behind poor long-term outcomes should include an examination of socioeconomic status as a potential contributor to reduced long-term mortality after injury.

UR - http://www.scopus.com/inward/record.url?scp=77950916742&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77950916742&partnerID=8YFLogxK

U2 - 10.1016/j.jss.2009.06.059

DO - 10.1016/j.jss.2009.06.059

M3 - Article

VL - 160

SP - 196

EP - 201

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 2

ER -