Does Universal Insurance Attenuate Racial Disparities in Trauma Outcomes?

Introduction : Race and insurance status are both independent predictors of outcome disparities after traumatic injury, but it remains unclear whether universal insurance may attenuate racial disparities. We investigated for the presence of racial disparities in a cohort of adult trauma patients with TRICARE coverage (military health system insurance).

Methods : We identified patients (age ≥18), including uniformed service personnel, dependents and retirees, who were treated in the United States for non-combat index injuries between 2006 and 2010. Included patients had a primary diagnosis of traumatic injury (ICD-9 800-959.9) and an Injury Severity Score (ISS) ≥9. Patients with superficial injuries, foreign body injuries and late effects were excluded. Patient demographics as well as clinical and hospital characteristics were compared by race. Multilevel logistic regression, adjusting for potential confounding and accounting for clustering of patients within hospitals, determined whether race is an independent predictor of mortality, major morbidity or readmission following traumatic injury among patients with universal insurance coverage. Interaction between trauma outcomes by race and hospital type (civilian or military) was tested.

Results : Identified trauma patients (N=19,024) were young (58% of patients age

Conclusion : Universal military insurance coverage was associated with resolution of racial disparities in morbidity, mortality and readmission after traumatic injury. While unmeasured confounders, including socioeconomic status, may limit direct comparison with an injured civilian population, these findings highlight a role for universal insurance coverage for traumatic injury to mitigate known racial disparities in outcomes.