Undiagnosed medical comorbidities in the uninsured

• DOI: 10.1097/ta.0b013e31826fc844
• Publication Date: 2012-11-01T09:29:50Z
• Authors: Vincent P. Duron; Sean F. Monaghan; Michael D. Connolly; Shea C. Gregg; Andrew H. Stephen; Charles A. Adams; William G. Cioffi; Daithi S. Heffernan
• Keywords: Adult; Male; Insurance, Health; Age Factors; Comorbidity; Middle Aged; Insurance Coverage; United States; 3. Good health; 03 medical and health sciences; Injury Severity Score; Logistic Models; Sex Factors; 0302 clinical medicine; Trauma Centers; Humans; Wounds and Injuries; Female; Healthcare Disparities; Retrospective Studies

BACKGROUND Lack of health care insurance has been correlated with increased mortality after trauma. Medical comorbidities significantly affect trauma outcomes. Access to and thereby being diagnosed a pretrauma comorbidity is highly dependent on status. The objective this study was determine whether rates or undiagnosed preexisting contribute disparities in observed between insured uninsured patients. METHODS Review patients admitted Level I center during 5-year period. Data extracted from the registry included age, sex, Injury Severity Score (ISS), comorbidities, mortality, Multivariate logistic regression analysis performed using status predict ISS, mortality. RESULTS Insured were older (54 years vs. 38, p < 0.001) more likely female (41.3% 22.5%, 0.001). When adjusting for age have diagnosis coronary artery disease (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.54–2.83), diabetes mellitus (OR, CI, 1.61–2.72), hypertension 1.97; 1.65–2.35), asthma/emphysema 1.64; 1.32–2.04), neurologic problems 1.79; 1.31–2.44), gastroesophageal reflux 2.03; 1.33–3.11), compared without insurance. In having protective 0.57; 0.45–0.71). Among no had lowest risk 0.5; 0.38–0.67). analyzing only impact 0.81; 0.53–1.22). CONCLUSION Undiagnosed play crucial role determining outcomes following Diagnosis medical may be marker access associated treatment, which explain gap LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III.