Insurance type and racial and ethnic disparities in ED mortality among trauma patients in Massachusetts (2008-2010)

Background: Understanding the role of health insurance in racial inequities in emergency medical care for traumatic injuries is important to policy considerations. Methods: We analyzed racial/ethnic disparities in emergency department (ED) mortality using data on the first ED visit for trauma treatment among patients aged 15 years and older in the Massachusetts Statewide Trauma Registry (2008-2010). Patients dead on arrival were excluded. Health insurance type was classified as Medicaid, Medicare, private and others. The analysis was stratified by insurance type and age group (<65y vs. >=65y), and adjusted for injury severity, sex, and age. Results: The 27,453 patients included 44.9% women, 83.4% non-Hispanic whites, 5.4% non-Hispanic blacks, 6.8% Hispanics, and 4.4% Asian or other races. In total, 534 (2.0%) died in ED. Compared to whites, blacks and Hispanics were more likely to be Medicaid beneficiaries (30% and 30% vs. 10%), less likely to be Medicare beneficiaries (14%, 11% vs. 43%). Among Medicaid beneficiaries aged under 65 years, blacks were twice more likely than whites to die in ED (OR=2.3, p=0.04). Among privately insured patients under 65 years of age, both blacks and Hispanics were twice more likely than whites to die in ED (OR=2.4, p<0.001; OR=2.1, p=0.003; respectively). Among Medicare beneficiaries aged 65 years and over, no significant racial/ethnic disparities were observed. Conclusions: Regardless of insurance type, significant black-white and Hispanic-white disparities in ED mortality existed among the trauma patients under 65 years of age. The role of insurance type in trauma care should be further investigated by age group.