Abstract
Introduction
Given the well-known healthcare disparities most pronounced in racial and ethnic minorities,
trauma healthcare in underrepresented patients should be examined, as in-hospital
bias may influence the care rendered to patients. This study seeks to examine racial
differences in outcomes and resource utilization among victims of gunshot wounds in
the United States.
Methods
This is a retrospective review of the National Trauma Data Bank (NTDB) conducted from
2007 to 2017. The NTDB was queried for patients who suffered a gunshot wound not related
to accidental injury or suicide. Patients were stratified according to race. The primary
outcome for this study was mortality. Secondary outcomes included racial differences
in resource utilization including air transport and discharge to rehabilitation centers.
Univariate and multivariate analyses were used to compare differences in outcomes
between the groups.
Results
A total of 250,675 patients were included in the analysis. After regression analysis,
Black patients were noted to have greater odds of death compared to White patients
(odds ratio [OR] 1.14, confidence interval [CI] 1.037-1.244; P = 0.006) and decreased odds of admission to the intensive care unit (ICU) (OR 0.76,
CI 0.732-0.794; P < 0.001). Hispanic patients were significantly less likely to be discharged to rehabilitation
centers (Hispanic: 0.78, CI 0.715-0.856; P < 0.001). Black patients had the shortest time to death (median time in minutes:
White 49 interquartile range [IQR] [9-437] versus Black 24 IQR [7-205] versus Hispanic 39 IQR [8-379] versus Asian 60 [9-753], P < 0.001).
Conclusions
As society carefully examines major institutions for implicit bias, healthcare should
not be exempt. Greater mortality among Black patients, along with differences in other
important outcome measures, demonstrate disparities that encourage further analysis
of causes and solutions to these issues.
Keywords
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References
- Racism and health: evidence and needed research.Annu Rev Public Health. 2019; 40: 105-125
- Structural racism and health inequities in the USA: evidence and interventions.Lancet. 2017; 389: 1453-1463
- Racial differences in chronic conditions and sociodemographic characteristics among high-utilizing veterans.J Racial Ethn Health Disparities. 2015; 2: 167-175
- Racial and ethnic disparities in diagnosis of chronic medical conditions in the USA.J Gen Intern Med. 2018; 33: 1116-1123
- Disparities in surgical access: a systematic literature review, conceptual model, and evidence map.J Am Coll Surg. 2019; 228: 276-298
- Counting the lives lost: how many black trauma deaths are attributable to disparities?.J Surg Res. 2013; 184: 480-487
- Disparities in trauma care and outcomes in the United States: a systematic review and meta-analysis.J Trauma Acute Care Surg. 2013; 74: 1195-1205
- Gunshot wounds to the head: racial disparities in inpatient management and outcomes.Neurosurg Focus. 2019; 47: E11
- Racial differences in treatment approaches and mortality following arterial trauma.Vasc Endovascular Surg. 2015; 49: 180-187
- Racial disparities in cranial gunshot wounds: intent and survival.J Racial Ethn Health Disparities. 2016; 3: 687-691
- Acute surgical decision-making in abdominal trauma is not altered by race or socioeconomic status.Am Surg. 2018; 84: 1869-1875
- The impact of race and socioeconomic status on treatment and outcomes of blunt splenic injury.J Surg Res. 2019; 240: 60-69
- Associations of distance to trauma care, community income, and neighborhood median age with rates of injury mortality.JAMA Surg. 2018; 153: 535-543
- Association between hospitals caring for a disproportionately high percentage of minority trauma patients and increased mortality: a nationwide analysis of 434 hospitals.Arch Surg. 2012; 147: 63-70
- Minority trauma patients tend to cluster at trauma centers with worse-than-expected mortality: can this phenomenon help explain racial disparities in trauma outcomes?.Ann Surg. 2013; 258 (discussion 9-81): 572-579
- Trends in racial disparities for injured patients admitted to trauma centers.Health Serv Res. 2013; 48: 1684-1703
- Unconscious race and class bias: its association with decision making by trauma and acute care surgeons.J Trauma Acute Care Surg. 2014; 77: 409-416
- Unconscious race and social class bias among acute care surgical clinicians and clinical treatment decisions.JAMA Surg. 2015; 150: 457-464
- Unconscious race and class biases among registered nurses: vignette-based study using implicit association testing.J Am Coll Surg. 2015; 220: 1077-1086.e3
- Ethnic disparities in emergency severity Index scores among U.S. Veteran's affairs emergency department patients.PLoS One. 2015; 10: e0126792
- Patient ethnicity affects triage assessments and patient prioritization in U.S. Department of veterans affairs emergency departments.Medicine (Baltimore). 2016; 95: e3191
- Racial differences in pediatric emergency department triage scores.J Emerg Med. 2016; 50: 720-727
- Disparities in timing of trauma consultation: a trauma registry analysis of patient and injury factors.J Surg Res. 2019; 242: 357-362
- Emergency department wait time and treatment of traumatic digit amputation: do race and insurance matter?.Plast Reconstr Surg. 2017; 139: 444e-454e
- Racial disparity in emergency department triage.J Emerg Med. 2013; 44: 511-518
- National trauma data standard data dictionary.(Available at:)https://www.facs.org/quality-programs/trauma/tqp/center-programs/ntdb/ntdsDate accessed: February 10, 2021
- The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.Int J Surg. 2014; 12: 1495-1499
- Systemic racism: science must listen, learn and change.Nature. 2020; 582: 147
- Racial and ethnic health disparities related to COVID-19.JAMA. 2021; 325: 719-720
- A public health crisis decades in the making: a review of 2019 CDC gun mortality data.(Available at:)
- Call to action: structural racism as a fundamental driver of health disparities: a presidential advisory from the American heart association.Circulation. 2020; 142: e454-e468
- National Academies of Sciences E, Medicine, Health.in: Baciu A. Negussie Y. Geller A. Weinstein J.N. Communities in Action: Pathways to Health Equity. National Academies Press (US), Washington (DC)2017
- Disparities in firearm injury: consequences of structural violence.Curr Trauma Rep. 2020; 6: 10-22
- Gunshot wound incidence as a persistent, tragic symptom of area deprivation.Surgery. 2020; 168: 671-675
- Firearm injury research and epidemiology: a review of the data, their limitations, and how trauma centers can improve firearm injury research.J Trauma Acute Care Surg. 2019; 87: 678-689
- Measuring racial bias in inpatient treatment.Am J Psychiatry. 1980; 137: 679-682
- The effect of race and ethnicity on outcomes among patients in the intensive care unit: a comprehensive study involving socioeconomic status and resuscitation preferences.Crit Care Med. 2011; 39: 429-435
- Impact of socioethnic factors on outcomes following traumatic brain injury.J Trauma. 2011; 70: 527-534
- Disparities in inter-hospital helicopter transportation for Hispanics by geographic region: a threat to fairness in the era of thrombectomy.J Stroke Cerebrovasc Dis. 2019; 28: 550-556
- Stroke and helicopter emergency medical service transports: an analysis of 25,332 patients.Air Med J. 2015; 34: 348-356
- Race/ethnicity and geographic access to urban trauma care.JAMA Netw Open. 2019; 2: e190138
- Are there racial disparities in trauma care?.World J Surg. 2009; 33: 23-33
- Trauma care does not discriminate: the association of race and health insurance with mortality following traumatic injury.J Trauma Acute Care Surg. 2015; 78: 1026-1033
- Racial disparities after vascular trauma are age-dependent.J Vasc Surg. 2016; 64: 418-424
Article info
Publication history
Published online: November 10, 2022
Accepted:
October 7,
2022
Received in revised form:
June 30,
2022
Received:
March 15,
2022
Footnotes
This manuscript was presented at the Committee on Trauma Region X Resident Research Competition. Seattle, WA, December 4th, 2021.
Identification
Copyright
Published by Elsevier Inc.
