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The Effect of Universal Insurance on Racial Disparities in Pediatric Trauma Outcomes and Healthcare Utilization After Discharge
Meesha Sharma, MD, MPH1, Wei Jiang, MS1, Cheryl Zogg, MSPH, MHS1, Muhammad Ali Chaudhary, MD1, Ritam Chowdhury, MBBS, MPH, PhD, SM1, Peter A Learn, MD2, Tracey Koehlmoos, PhD, MHA2, Andrew J Schoenfeld, MD, MSc.1, Adil H Haider, MD, MPH, FACS1. 1Center for Surgery and Public Health, Harvard Medical School and Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA, 2Uniformed Services University of Health Sciences, Bethesda, MD, USA.

Background: Racial disparities in mortality exist among pediatric trauma patients; however, little is known about disparities in long-term outcomes of care and subsequent healthcare utilization. We examined differences in outcomes and healthcare utilization after discharge between Black and White children within a universally-insured, longitudinally-followed trauma population.

Methods: Data from the military health insurance database, TRICARE, were analyzed for 2006-2010. Children <18y with a primary trauma diagnosis (ICD-9CM 800-959) and ISS >9 were included. Each child was assigned her sponsor parent's race. Children with primary diagnoses of burns, foreign body injuries, late effects and missing race were excluded. Differences in morbidity and healthcare utilization (readmission, number of outpatient visits) within 30 and 90 days of discharge were compared by race (Black vs. White). Differences in index length of stay (LOS) were also considered. Binary outcomes were evaluated with multivariable logistic regression, and continuous outcomes with negative binomial models.

Results: Of the 3,124 children included, 71.3% were White and 13.1% were Black. After adjusting for age, gender, sponsor rank (a proxy for SES), system of care and injury severity, no significant differences were detected between Black and White children in terms of their index length of stay, or morbidity and healthcare utilization within 30 or 90 days of discharge.

Conclusions: In a universally insured population, Black and White children receiving trauma care had similar outcomes and healthcare utilization rates up to 90 days following discharge. Universal insurance coverage may play an important role in mitigating race based disparities in pediatric trauma care.

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