Abstract
Purpose
Uninsured children face health-related disparities in screening, treatment, and outcomes.
To ensure payer status would not influence the decision to provide emergency care,
the Emergency Medical Treatment and Active Labor Act (EMTALA) was passed in 1986,
which states patients cannot be refused treatment or transferred from one hospital
to another when medically unstable. Given findings indicating the widespread nature
of disparities based on insurance, we hypothesized that a disparity in patient outcome
(death) after trauma among the uninsured may exist, despite the EMTALA.
Methods
Data on patients age 17 years or younger (n = 174,921) were collected from the National
Trauma Data Bank (2002-2006), containing data from more than 900 trauma centers in
the United States. We controlled for race, injury severity score, sex, and injury
type to detect differences in mortality among the uninsured and insured. Logistic
regression with adjustment for clustering on hospital was used.
Results
Crude analysis revealed higher mortality for uninsured children and adolescents compared
with the commercially or publicly insured (odds ratio [OR] 2.97; 95% confidence interval
[CI], 2.64-3.34; P < .001). Controlling for sex, race, age, injury severity, and injury type, and clustering
within hospital facility, uninsured children had the highest mortality compared with
the commercially insured (OR, 3.32; 95% CI, 2.95-3.74; P < .001], whereas children and adolescents with Medicaid also had higher mortality
(OR, 1.19; 95% CI, 1.07-1.33; P = .001).
Conclusions
These results demonstrate that uninsured and publicly insured American children and
adolescents have higher mortality after sustaining trauma while accounting for a priori
confounders. Possible mechanisms for this disparity include treatment delay, receipt
of fewer diagnostic tests, and decreased health literacy, among others.
Key words
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Article info
Publication history
Accepted:
December 17,
2008
Received in revised form:
December 15,
2008
Received:
November 7,
2008
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
