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Post-trauma survival differs between race, age
In survival after trauma, younger white patients experienced better outcomes compared with younger black patients; however, recent study results showed this trend was reversed among older patients.
Researchers identified 1,073,195 trauma patients from the Nationwide Inpatient Sample using International Classification of Disease, Ninth Revision, Clinical Modification diagnosis codes. By applying the Trauma Mortality Prediction Model, the researchers gathered injury severity while using the Charlson Comorbidity Index to quantify patient comorbidities. Main outcome measures included in-hospital mortality after trauma for blacks vs. whites for younger and older patients compared using univariable logistic regression, multivariable logistic regression with and without clustering for hospital effects and coarsened exact matching.
Most of the older patients were white, female and insured, and had Charlson Comorbidity Index scores of 1 or higher. The researchers found an unadjusted odds ratio for death in blacks vs. whites of 1.35 for patients 16 to 64 years of age and 1 for patients 65 years or older. Racial disparities in survival persisted in the younger black group; however, after risk adjustment, these results were reversed in the older group and were consistent across all three statistical methods, according to the researchers.
“We have long found it vexing that minority patients consistently do worse, even in treatment for trauma that seems to leave little room for bias,” study author Adil Haider, MD, MPH, an associate professor of surgery at the Johns Hopkins University School of Medicine, stated in a press release about the study from Johns Hopkins. “And although we still see the disparity in younger black patients, we were surprised to find in this study that older black trauma patients were more likely to survive their injuries.”
Disclosure: Haut is primary investigator of the Mentored Children Scientist Development Award, received royalties from Lippincott Williams & Wilkins and honoraria for various speaking engagements, and gave expert witness testimony in various medical malpractice cases.