A Multistate Study of Race and Ethnic Disparities in Access to Trauma Care.
BACKGROUND
There are well-documented disparities in outcomes for injured Black and Hispanic patients in the United States. However, patient level characteristics cannot fully explain the differences in outcomes and system-level factors, including the trauma center designation of the hospital to which a patient presents, may contribute to their worse outcomes. We aim to determine if Black and Hispanic patients are more likely to be undertriaged, compared with white patients.


METHODS
This is a retrospective, cross-sectional, population-based study that uses data from the 2014 Agency for Healthcare Research and Quality Healthcare Costs and Utilization Project State Inpatient Databases. We included data from all states with available State Inpatient Databases data that included both race and hospital characteristics needed for analysis (n = 18). Logistic regression was used to identify predictors of severely injured (Injury Severity Score ≥16) patients being brought to a trauma center.


RESULTS
We identified 70,970 severely injured trauma patients with complete data. Non-Hispanic White represented 74.1% of the study population, 9.8% were non-Hispanic Black, and 9.7% were Hispanic. After adjustment for other demographic and injury characteristics, Non-Hispanic Black and Hispanic patients were more likely to be undertriaged, compared with white patients (odds ratio, 1.20; 95% confidence interval, 1.12-1.29 and odds ratio, 1.39; 95% confidence interval, 1.29-1.48, respectively). Male sex and older age were associated with higher odds of undertriage, whereas urban residence, high injury severity, and penetrating injury were associated with lower odds of undertriage.


CONCLUSIONS
Severely injured Black and Hispanic trauma patients are more likely to be undertriaged than otherwise similar white patients. The factors that contribute to racial and ethnic disparities in receiving trauma center care need to be identified and addressed to provide equitable trauma care.
['Alber|Daniel A|DA|', 'Dalton|Michael K|MK|', 'Uribe-Leitz|Tarsicio|T|', 'Ortega|Gezzer|G|', 'Salim|Ali|A|', 'Haider|Adil H|AH|', 'Jarman|Molly P|MP|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D044383:Blacks D003430:Cross-Sectional Studies D005260:Female D054625:Healthcare Disparities D006630:Hispanic or Latino D006801:Humans D008297:Male D008875:Middle Aged D012189:Retrospective Studies D014218:Triage D014481:United States D014947:Wounds and Injuries D055815:Young Adult
Disparities Injury Emergency medical services Trauma systems Triage