Socioeconomics affecting quality outcomes in Asian trauma patients within the United States

Krista L. Haines*, Suresh Agarwal, Hee Soo Jung

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Introduction: Asian-Americans and Pacific Islanders are often considered as a uniform group when examining race in health outcomes. However, the generally favorable economic outcomes in this group belie significant socioeconomic variance between its heterogeneous subgroups. This study evaluates the impact of socioeconomic status on the health outcomes of Asian trauma patients. Methods: From 2012 to 2015, 52,704 Asians who presented to trauma centers were registered with the National Trauma Data Bank with known disposition. Chi 2 and multivariate logistic regression analysis for mortality were performed controlling for age, gender, comorbidities, injury severity, insurance, race, and ethnicity. Negative binomial regression analysis with margins for length of stay (LOS) was performed. Subgroup analysis was done for polytrauma (Injury Severity Score >15, n = 14,787). Results: Asians represent 1.8% of the trauma population. Uninsured Asians were 1.9 times more likely to die than privately insured Asians (P < 0.001). Medicare patients were 1.8 times more likely to die (P < 0.001). Eighty-one Asians identified themselves as Hispanic, and there was no significant difference in their mortality or LOS for this group (P = 0.06, P = 0.18). Bleeding disorders, diabetes, cirrhosis, hypertension, respiratory disease, cancer, esophageal varices, angina, cerebrovascular accident, and dependent health care before trauma all individually affected mortality and were controlled for in this model (P < 0.05). LOS was 1.7 d longer in Medicaid patients (2.2 d with polytrauma) and 1.1 d longer in workman's compensation patients (2.1 d with polytrauma). Uninsured had a shorter LOS (P < 0.005). Asian males with polytrauma stayed 1.6 d longer than females (P < 0.001), and age did not affect LOS for this group. Conclusions: Noteworthy socioeconomic disparities influence Asian trauma patients independent of their race. Mortality is affected by insurance status, despite controlling for injury severity and comorbidities.

Original languageEnglish
Pages (from-to)63-67
Number of pages5
JournalJournal of Surgical Research
Volume228
DOIs
StatePublished - Aug 2018
Externally publishedYes

Keywords

  • Asian disparities
  • Asian-American trauma
  • Trauma
  • Trauma outcomes

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