Racial disparities in trauma deaths not seen with Tricare



(Reuters Health) – With the same health insurance and access to the same medical providers, black trauma patients may be no more likely to die than their white counterparts, a U.S. study suggests.

Even though all U.S. hospitals are required to treat trauma patients regardless of their ability to pay, plenty of previous research has found minority patients often have worse survival odds and more complications than white patients. One of the many reasons for this may be that white patients have better medical benefits and an easier time accessing and affording care.

For the current study, researchers examined data on 87,112 trauma patients with insurance through Tricare, the U.S. health program for military service members and their families. All of the patients were treated at military and civilian trauma centers from 2006 to 2014.

The mortality rate was 1.2 percent for both black and white patients, researchers report in the journal Surgery.

This suggests that giving patients all the same benefits and the same access to care can help eliminate historic racial disparities in trauma outcomes, said senior study author Dr. Andrew Schoenfeld, a researcher at Brigham and Women’s Hospital and Harvard Medical School in Boston.

“We believe this is the result of the effect of universal insurance and an equal access healthcare system,” Schoenfeld said by email.

While it might be tempting to attribute the lack of disparities in death rates to something unique about Tricare or the military culture, many of the patients were treated at civilian medical centers where the vast majority of patients were not active duty service members, Schoenfeld added.

Overall, 10 percent of the patients suffered major complications within 30 days and 13 percent had serious problems within 90 days, the study found.

About 9 percent of the patients had repeat hospitalizations, or readmissions, within 30 days of going home.

Black patients, however, were 9 percent less likely to experience major complications and 13 percent less likely to have repeat hospitalizations within 90 days of discharge.

The study wasn’t a controlled experiment designed to prove whether or how giving every patient the same insurance might influence trauma survival odds or other outcomes.

Another drawback of the study is that researchers relied on insurance claims data to assess how well patients did in the hospital, and these records may not capture all of the factors that can influence survival odds or the risk of complications, the authors note.

“This is an interesting paper but it is very far from being able to conclude that universal insurance and access eliminated disparities,” said Dr. Harlan Krumholz, a researcher at Yale University in New Haven, Connecticut, who wasn’t involved I the study.

“The people covered by Tricare are different than the general population – and the hospitals and health care institutions may be also,” Krumholz said by email. “Making a causal inference is just not possible.”

SOURCE: bit.ly/2kH2W5W Surgery, online December 5, 2017.

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