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World Journal of Surgery
Published in: World Journal of Surgery 9/2020

01-09-2020 | Scientific Review

Disparities in Adult and Pediatric Trauma Outcomes: a Systematic Review and Meta-Analysis

Authors: Carol Sanchez, Saamia Shaikh, Brianna Dowd, Radleigh Santos, Mark McKenney, Adel Elkbuli

Published in: World Journal of Surgery | Issue 9/2020

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Abstract

Background

Although safeguards requiring emergency care are provided regardless of a patient’s payor status, disparate outcomes have been reported in trauma populations. The purpose of this systematic review and meta-analysis was to determine whether race/ethnicity or insurance status had an effect on mortality and to systematically present the literature in the adult and pediatric trauma populations during the last decade.

Methods

An online search of PubMed, Cochrane Library, Google Scholar, and SAGE Journals was performed for publications from January 2009 to March 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used. The GRADE Working Group criteria were utilized to assess the evidence quality. A meta-analysis was conducted to compare mortality between insured/uninsured and Caucasian/non-Caucasian patients.

Results

Our search revealed 680 publications that qualified for evaluation. Of these, 41 were included in the final analysis. Twenty-six studies included adults only, nine studies included pediatric patients only, and six studies evaluated both. Twelve studies evaluated the effects of race/ethnicity, 18 examined insurance status, and 11 investigated both. Uninsured patients had 22% greater odds of death than insured patients (OR 1.22; CI 1.21–1.24). Non-Caucasian patients had 18% greater risk of death than Caucasian patients (OR 1.18; CI 1.17–1.20).

Conclusion

Both the adult and pediatric trauma populations suffer outcome disparities based on race/ethnicity and insurance status. Overall, patients without insurance coverage and minority groups (i.e., non-Caucasians) had worse outcomes, as measured by odds of death and all-cause mortality.
Appendix
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Metadata
Title
Disparities in Adult and Pediatric Trauma Outcomes: a Systematic Review and Meta-Analysis
Authors
Carol Sanchez
Saamia Shaikh
Brianna Dowd
Radleigh Santos
Mark McKenney
Adel Elkbuli
Publication date
01-09-2020
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 9/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-020-05591-2

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