People who are uninsured are more likely to die following admission to the hospital for trauma, reveals a new US study.
The research involving 687,091 American patients age 18 and older has shown that uninsured adults have a 25 percent higher risk of mortality than insured adults, accounting for approximately 18,000 deaths per year in excess in the country.
According to authors, lack of insurance may increase the risk of death after trauma in several ways. Uninsured patients may experience treatment delay; receive different care, including fewer diagnostic tests; or possess a lower rate of health literacy.
They added evidence regarding the effects of lack of insurance on traumatically injured patients suggests that they are at added risk.
The study led by Dr Heather Rosen, M.P.H., of Children's Hospital Boston and Harvard Medical School revealed that uninsured patients had the highest rate of death following admission for trauma, even after controlling for age, sex, race and severity and mechanism of injury.
An analysis of patients age 18 to 30 - selected because they were less likely to have co-occurring illnesses - revealed that uninsured patients in this group still had the highest odds of death.
The same was true in a subanalysis of only patients with head injuries and in another analysis of those with one or more co-occurring illnesses.
"Most recent research has concentrated on decreased (or lack of) access to care as a result of being uninsured. However, we found that, even after admission to a hospital, trauma patients can have worse outcomes based on insurance status," the authors write.
"In addition, treatment often is initiated before payer status is recognized; thus, this provokes the question of whether differences exist in processes of care during the hospital stay," they conclude.
"We can only speculate as to the mechanism of the disparities we have exposed; the true causes are still unclear. Although the lack of insurance may not be the only explanation for the disparity in trauma mortality, the accidental costs of being uninsured in the United States today may be too high to continue to overlook," they added.
The study appears in Archives of Surgery, one of the JAMA/Archives journals.