A Racial Divide

CHICAGO — Blacks and Hispanics who receive treatment for head injuries and other trauma are more likely to die afterward than whites with similar injuries, and, regardless of race, trauma victims who lacked insurance died much more often than those who were insured, new research shows.

The study, published in this week’s Archives of Surgery, offers the latest evidence of how race and insurance status affect patient outcomes — whether the condition in question is cancer, heart disease or diabetes.

In theory, trauma centers, which treat victims of car accidents, falls, gunshot wounds and stabbings, are “both colorblind and insurance-blind,” said Dr. Marie Crandall, one of the study’s authors and a surgery professor at Northwestern University’s Feinberg School of Medicine. “Everyone who has an injury is treated the same based on injury severity . . . as opposed to who they are, where they live or whether they have insurance. It would be a violation of federal law not to treat trauma that way.”

Yet, based on data from more than 376,000 patients at 700 hospitals, the researchers found that trauma victims who were white and had health insurance fared better than blacks, Hispanics and the uninsured, even when the severity of the injury was the same.

Lack of insurance was the biggest predictor of poor outcomes. And minorities were more likely than whites to be uninsured.

But Hispanics with insurance were still 51 percent more likely to die after being treated for a trauma wound than whites who had insurance, said Dr. Adil Haider, of Johns Hopkins University’s School of Medicine, the lead author of the research.

African Americans with insurance had a 20 percent higher mortality rate than insured whites.

Haider said uninsured and minority patients might be more likely to have pre-existing medical conditions that would lower their chances of surviving a serious trauma wound.

They also are more likely to be treated in under-resourced hospitals that tend to have worse patient outcomes, said Romana Hasnain-Wynia, director of Northwestern’s Center for Healthcare Equity.

Hasnain-Wynia, who was not involved in the study, said universal health-care coverage could help close the gap.

“As a nation, we need to tackle the lack of insurance for over 47 million people, as well as tackle the ongoing role that segregation in health care plays in contributing to health care disparities,” she said.

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