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Minorities More Likely to Die in ER
Date:10/20/2008

th insurance may mean that blacks and Hispanics are less likely to call for an ambulance after being injured. So, by the time they reach the hospital, their condition is more serious than a similarly injured white, insured patient.

Access to trauma care is near universal in the United States, so these dramatic differences in patients with and without insurance are unexpected, Haider said. "The study also shows that there are racial disparities in survival after trauma, and differences in insurance between whites and minorities that cannot explain away these disparities," he said. "Now that we know this, we can go about understanding exactly why these disparities exist and try to come up with solutions."

Dr. Wally Ghurabi, emergency department director at Santa Monica-UCLA Medical Center, believes factors other than insurance and in-hospital care may account for the increased deaths among minority patients.

"This paper raised more questions than answers," Ghurabi said. "One significant component of trauma victim's care is the pre-hospital phase. When an African-American or Hispanic is shot in the [now closed] Martin Luther King Hospital vicinity, transport times are increased -- taking away from that 'golden hour' [of emergency care]. That may be true of other poor communities in the U.S. Whether these patients are insured or not, when you lose minutes in transport you are dealing with a sicker patient," he said.

"I could not get myself to agree with the idea that insurance status determines initial aspect of the care," he said. "But it could be of significance in rehabilitation and whether the patient is compliant or not."

More information

For more on trauma care, visit the American College of Emergency Physicians.



SOURCES: Adil H. Haider, M.D., M.P.H., Johns Hopkins School of Medicine, Balt
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