Lower extremity vascular injuries: Increased mortality for minorities and the uninsured?

Marie Crandall, Douglas Sharp, Karen Brasel, Mercedes Carnethon, Adil Haider, Thomas Esposito

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: There is increasing evidence to suggest that racial disparities exist in outcomes for trauma. Minorities and the uninsured have been found to have higher mortality rates for blunt and penetrating trauma. However, mechanisms for these disparities are incompletely understood. Limiting the inquiry to a homogenous group, those with lower extremity vascular injuries (LEVIs), may clarify these disparities. Methods: The National Trauma Data Bank (NTDB; version 7.0, American College of Surgeons) was used for this study. LEVIs were identified using codes from the International Classification of Diseases, 9th revision. Univariate and multivariate analyses were performed using Stata software (version 11; StataCorp, LP, College Station, TX). Results: Records were reviewed for 4,928 LEVI patients. The mechanism of injury was blunt in 2,452 (49.8%), penetrating in 2,452 (49.8%), and unknown in 24 cases (0.5%). Mortality was similar by mechanism (7.6% overall). Regression analysis using mechanism as a covariate revealed a significantly worse mortality for people of color (POC; odds ratio [OR], 1.45; 95% confidence interval [CI], 1.03-2.02; P =.03) and the uninsured (UN; OR, 1.62; 95% CI, 1.15-2.23; P =.006). However, when separate analyses were performed stratifying by mechanism, no significant mortality disparities were found for blunt trauma (POC OR, 1.28; 95% CI, 0.85-1.96; P =.23; UN OR, 1.33; 95% CI, 0.78-2.22; P =.29), but disparities remained for penetrating trauma (POC OR, 1.81; 95% CI, 0.93-3.57; P =.08; UN OR, 1.85; 95% CI, 1.18-2.94; P =.009). Conclusion: For patients with LEVI, mortality disparities based on race or insurance status were only observed for penetrating trauma. It is possible that injury heterogeneity or patient cohort differences may partly explain mortality disparities that have been observed between racial and socioeconomic groups.

Original languageEnglish (US)
Pages (from-to)656-664
Number of pages9
JournalSurgery
Volume150
Issue number4
DOIs
StatePublished - Oct 2011
Externally publishedYes

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Vascular System Injuries
Lower Extremity
Odds Ratio
Confidence Intervals
Mortality
Wounds and Injuries
United Nations
Nonpenetrating Wounds
Insurance Coverage
International Classification of Diseases
Software
Multivariate Analysis
Color
Regression Analysis
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

Lower extremity vascular injuries : Increased mortality for minorities and the uninsured? / Crandall, Marie; Sharp, Douglas; Brasel, Karen; Carnethon, Mercedes; Haider, Adil; Esposito, Thomas.

In: Surgery, Vol. 150, No. 4, 10.2011, p. 656-664.

Research output: Contribution to journalArticle

Crandall, M, Sharp, D, Brasel, K, Carnethon, M, Haider, A & Esposito, T 2011, 'Lower extremity vascular injuries: Increased mortality for minorities and the uninsured?', Surgery, vol. 150, no. 4, pp. 656-664. https://doi.org/10.1016/j.surg.2011.07.052
Crandall, Marie ; Sharp, Douglas ; Brasel, Karen ; Carnethon, Mercedes ; Haider, Adil ; Esposito, Thomas. / Lower extremity vascular injuries : Increased mortality for minorities and the uninsured?. In: Surgery. 2011 ; Vol. 150, No. 4. pp. 656-664.
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title = "Lower extremity vascular injuries: Increased mortality for minorities and the uninsured?",
abstract = "Background: There is increasing evidence to suggest that racial disparities exist in outcomes for trauma. Minorities and the uninsured have been found to have higher mortality rates for blunt and penetrating trauma. However, mechanisms for these disparities are incompletely understood. Limiting the inquiry to a homogenous group, those with lower extremity vascular injuries (LEVIs), may clarify these disparities. Methods: The National Trauma Data Bank (NTDB; version 7.0, American College of Surgeons) was used for this study. LEVIs were identified using codes from the International Classification of Diseases, 9th revision. Univariate and multivariate analyses were performed using Stata software (version 11; StataCorp, LP, College Station, TX). Results: Records were reviewed for 4,928 LEVI patients. The mechanism of injury was blunt in 2,452 (49.8{\%}), penetrating in 2,452 (49.8{\%}), and unknown in 24 cases (0.5{\%}). Mortality was similar by mechanism (7.6{\%} overall). Regression analysis using mechanism as a covariate revealed a significantly worse mortality for people of color (POC; odds ratio [OR], 1.45; 95{\%} confidence interval [CI], 1.03-2.02; P =.03) and the uninsured (UN; OR, 1.62; 95{\%} CI, 1.15-2.23; P =.006). However, when separate analyses were performed stratifying by mechanism, no significant mortality disparities were found for blunt trauma (POC OR, 1.28; 95{\%} CI, 0.85-1.96; P =.23; UN OR, 1.33; 95{\%} CI, 0.78-2.22; P =.29), but disparities remained for penetrating trauma (POC OR, 1.81; 95{\%} CI, 0.93-3.57; P =.08; UN OR, 1.85; 95{\%} CI, 1.18-2.94; P =.009). Conclusion: For patients with LEVI, mortality disparities based on race or insurance status were only observed for penetrating trauma. It is possible that injury heterogeneity or patient cohort differences may partly explain mortality disparities that have been observed between racial and socioeconomic groups.",
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T2 - Increased mortality for minorities and the uninsured?

AU - Crandall, Marie

AU - Sharp, Douglas

AU - Brasel, Karen

AU - Carnethon, Mercedes

AU - Haider, Adil

AU - Esposito, Thomas

PY - 2011/10

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N2 - Background: There is increasing evidence to suggest that racial disparities exist in outcomes for trauma. Minorities and the uninsured have been found to have higher mortality rates for blunt and penetrating trauma. However, mechanisms for these disparities are incompletely understood. Limiting the inquiry to a homogenous group, those with lower extremity vascular injuries (LEVIs), may clarify these disparities. Methods: The National Trauma Data Bank (NTDB; version 7.0, American College of Surgeons) was used for this study. LEVIs were identified using codes from the International Classification of Diseases, 9th revision. Univariate and multivariate analyses were performed using Stata software (version 11; StataCorp, LP, College Station, TX). Results: Records were reviewed for 4,928 LEVI patients. The mechanism of injury was blunt in 2,452 (49.8%), penetrating in 2,452 (49.8%), and unknown in 24 cases (0.5%). Mortality was similar by mechanism (7.6% overall). Regression analysis using mechanism as a covariate revealed a significantly worse mortality for people of color (POC; odds ratio [OR], 1.45; 95% confidence interval [CI], 1.03-2.02; P =.03) and the uninsured (UN; OR, 1.62; 95% CI, 1.15-2.23; P =.006). However, when separate analyses were performed stratifying by mechanism, no significant mortality disparities were found for blunt trauma (POC OR, 1.28; 95% CI, 0.85-1.96; P =.23; UN OR, 1.33; 95% CI, 0.78-2.22; P =.29), but disparities remained for penetrating trauma (POC OR, 1.81; 95% CI, 0.93-3.57; P =.08; UN OR, 1.85; 95% CI, 1.18-2.94; P =.009). Conclusion: For patients with LEVI, mortality disparities based on race or insurance status were only observed for penetrating trauma. It is possible that injury heterogeneity or patient cohort differences may partly explain mortality disparities that have been observed between racial and socioeconomic groups.

AB - Background: There is increasing evidence to suggest that racial disparities exist in outcomes for trauma. Minorities and the uninsured have been found to have higher mortality rates for blunt and penetrating trauma. However, mechanisms for these disparities are incompletely understood. Limiting the inquiry to a homogenous group, those with lower extremity vascular injuries (LEVIs), may clarify these disparities. Methods: The National Trauma Data Bank (NTDB; version 7.0, American College of Surgeons) was used for this study. LEVIs were identified using codes from the International Classification of Diseases, 9th revision. Univariate and multivariate analyses were performed using Stata software (version 11; StataCorp, LP, College Station, TX). Results: Records were reviewed for 4,928 LEVI patients. The mechanism of injury was blunt in 2,452 (49.8%), penetrating in 2,452 (49.8%), and unknown in 24 cases (0.5%). Mortality was similar by mechanism (7.6% overall). Regression analysis using mechanism as a covariate revealed a significantly worse mortality for people of color (POC; odds ratio [OR], 1.45; 95% confidence interval [CI], 1.03-2.02; P =.03) and the uninsured (UN; OR, 1.62; 95% CI, 1.15-2.23; P =.006). However, when separate analyses were performed stratifying by mechanism, no significant mortality disparities were found for blunt trauma (POC OR, 1.28; 95% CI, 0.85-1.96; P =.23; UN OR, 1.33; 95% CI, 0.78-2.22; P =.29), but disparities remained for penetrating trauma (POC OR, 1.81; 95% CI, 0.93-3.57; P =.08; UN OR, 1.85; 95% CI, 1.18-2.94; P =.009). Conclusion: For patients with LEVI, mortality disparities based on race or insurance status were only observed for penetrating trauma. It is possible that injury heterogeneity or patient cohort differences may partly explain mortality disparities that have been observed between racial and socioeconomic groups.

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