A Multifactorial Analysis of Trauma Outcomes: Comorbidities, Race, and Socioeconomic Status

Introduction: Trauma patients with comorbid conditions are known to have poorer outcomes. We hypothesize that these outcomes are further influenced by race or ethnicity and socioeconomic status. Methods: We queried patient records in the Trauma Quality Improvement Program database from 2017 to 2019 and assessed those with selected comorbidities: chronic kidney disease (CKD), diabetes, cardiac comorbidities (angina pectoris, congestive heart failure, myocardial infarct, and hypertension), and chronic obstructive pulmonary disease (COPD). We used multivariate logistic and linear regression models to investigate the interaction of race or ethnicity and insurance status in trauma patients with the above comorbidities, adjusting for injury severity, demographic factors, and other comorbidities. Results: We identified 44,388 patients with CKD, 357,008 with diabetes, 947,980 with cardiac comorbidities, and 205,525 with COPD from a total of 2,493,327 records. Patients were mostly White and non-Hispanic, with Medicare as a payor; patients with diabetes and CKD were male, while patients with cardiac comorbidities and COPD were female. Minority patients had increased hospital mortality and longer hospital stays; length of stay was associated with differences in payor and with increases or decreases observed across different payor-comorbidity interactions. Discharge dispositions were also associated with differences in race or ethnicity and payor. Conclusions: In an analysis of trauma patients with specific comorbidities, racial or ethnic background and socioeconomic status were associated with differences in outcomes, even after adjusting for injury severity and other factors. These results indicate that comorbidity indices alone are insufficient for optimal patient care, necessitating the inclusion of social determinants in treatment and discharge planning. Published by Elsevier Inc.