Abstract
BACKGROUND: Lack of health insurance (NO-INS) is associated with increased long-term mortality after head and spinal cord injuries (NEURO-TRA). Less is known about the influence of insurance type and long-term mortality following non-NEURO-TRA. We hypothesized that NO-INS would be associated with 2-y mortality after moderate to severe injury. METHODS: Adults (>or=18) treated at a level-I trauma center following a moderate to severe blunt injury (ISS>15) and without NEURO-TRA from 2000-2005 and discharged alive were eligible for the study. Two-y mortality was determined utilizing the Social Security Administration Death Master File. Logistic regression analysis was used to determine if type of insurance [NO-INS, Private (PRIV-INS), Medicare/Medicaid; GOV-INS), or Other (OTH-INS)] was related to 2-y mortality. RESULTS: One thousand nine hundred fifty-eight patients met study inclusion/exclusion criteria. Two-y risk of death was 2.96%. On univariate analysis, admission age, lactate, and insurance type were associated with 2-y mortality (P<0.25). However, race was not. After adjusting for admission age and lactate, compared with PRIV-INS, having either NO-INS or GOV-INS was significantly associated with increased 2-y mortality. The analysis was repeated without patients eligible for Medicare (Age>or=65), and GOV-INS was still associated with increased 2-y mortality (OR 4.47 P<0.05). CONCLUSION: Following moderate to severe blunt, non-NEURO-TRA, having GOVT-INS or NO-INS was associated with increased 2-y mortality. The mechanism by which this association may be explained is unclear. Future research focused on elucidating mechanisms behind poor long-term outcomes should include an examination of socioeconomic status as a potential contributor to reduced long-term mortality after injury.