Racial Disparities at Mixed-Race and Minority Hospitals : Treatment of African American Males With High-Grade Splenic Injuries.
INTRODUCTION
Racial and socioeconomic disparities in health access and outcomes for many conditions is well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American ([AA] vs White) males with high-grade splenic injuries.


METHODS
Data from the National Trauma Data Bank were utilized from 2007 to 2015; 24 855 AA or White males with high-grade splenic injuries were included. Multilevel mixed-effects regression analysis was used to evaluate disparities in outcomes and resource allocation.


RESULTS
Mortality was significantly higher for AA males at mixed-race (OR 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI, 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2, P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08).


DISCUSSION
While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.
['Tignanelli|Christopher J|CJ|', 'Watarai|Bradly|B|', 'Fan|Yunhua|Y|', 'Petersen|Ashley|A|', 'Hemmila|Mark|M|', 'Napolitano|Lena|L|', 'Jarosek|Stephanie|S|', 'Charles|Anthony|A|']
D015998:Abbreviated Injury Scale D000293:Adolescent D000328:Adult D001741:African Americans D000368:Aged D019992:Databases as Topic D054625:Healthcare Disparities D017052:Hospital Mortality D006801:Humans D008297:Male D008875:Middle Aged D008913:Minority Groups D044469:Racial Groups D040841:Resource Allocation D013154:Spleen D016896:Treatment Outcome D055815:Young Adult
racial disparities splenic trauma trauma systems