Trauma Listserv

No Insurance? That�s a Killer

No Insurance? That�s a Killer.
Uninsured patients are 50 percent more likely to die of traumatic injuries than those with health insurance.

David Noonan
NEWSWEEK
From the magazine issue dated Nov 10, 2008

Reading medical journals can be a real headache. Sure, the topics are important, but the demands of scientific accuracy make for dense, technical prose. The language is almost always an agony of arcane jargon and clunky grammar. Long, tangled sentences, heavy with terms like "multivariate analyses," are assembled to make small points. Research methods are explained in exhaustive detail, while conclusions are larded with caveats and qualifiers that pretty much render them inconclusive. It's the literary equivalent of wet cement.

Every now and then, however, you come across a statement that is the exact opposite of all that�a few simple words of plain English freighted with meaning. I encountered such a sentence in a study that appeared in the October issue of Archives of Surgery. Here it is: "In brief, insurance represents more than just the ability to pay a bill." That is as clean and concise a summation of a profound and complicated truth as I have come across since I first started paying attention to health-insurance issues more than a decade ago.

Of course, what insurance (and the lack of it) often represents, as numerous studies have shown, is the difference between care and no care, between an early cancer diagnosis and a late diagnosis, between properly managing a chronic condition like asthma and waiting until a dangerous attack occurs. For some of the patients in the Archives of Surgery study, which was led by Johns Hopkins trauma surgeon Adil Haider, what insurance represented was nothing less than the difference between life and death.

Drawing on the National Trauma Data Bank, which collects information from approximately 700 U.S. trauma centers and hospital emergency departments, Haider and his colleagues analyzed almost 430,000 moderate to severe cases of traumatic injury (from auto accidents, gunshots and other causes) treated between 2001 and 2005. Controlling for age, gender, type and severity of injury, they found that, overall, uninsured patients were 50 percent more likely to die from their injuries than insured patients. Among white patients, the mortality rate for those with insurance was 4.2 percent, compared with 7.9 percent for the uninsured. The numbers for minorities were worse. Uninsured African-Americans died at more than double the rate of the insured, 11.4 percent to 4.9 percent. And while 6.3 percent of insured Hispanic patients died after traumatic injury, the rate for uninsured Hispanics was 11.3 percent.

The study also uncovered dramatic differences in survival rates for patients of different races and insurance status. When compared with an insured white patient, black patients with equivalent injuries but without insurance had a 78 percent higher risk of dying; for uninsured Hispanics, the risk was 130 percent higher.
The findings by Haider and his colleagues erase any illusion that emergency care is the great equalizer in our health-care system, that our differences get left behind when we are rolled through those double doors, injured and in danger of dying.

Haider, who says that 60 percent of the patients he treats are uninsured, acknowledges that his study raises more questions than it answers. He can list possible reasons why the uninsured are more likely to die after trauma�they may have untreated underlying conditions due to a lack of routine care; they may delay seeking help after an injury�but knows more research is needed. One factor he is concerned about is the potential role of bias, conscious and unconscious. "We need to at least ask the question," he says. "Are we treating patients differently based on insurance status or race?" There's that plain English again.

URL: http://www.newsweek.com/id/166854

Deer Crash Summary

The attached article is from the Upper Great Plains Transportation Institue, NDSU. Please click on the website for more articles http://www.ugpti.org/rtssc/briefs/

Trauma Article from JEMS

Click on Link to view artilce http://www.jems.com/news_and_articles/news/blood_substitute_fails.html

Primary Belt Law and Insurance Rates

FYI
Originally sent by Carol Thurn from NDDOT

Attached is a report from the Property Casualty Insurers Association of America on the relationship between PBL and car insurance premiums. This report stemmed from a question from another Region 8 SHSO on the role of PBL in lowering car insurance rates (or at least slowing the rate on increase), a topic that NHTSA has not covered in-depth. While the report was not able to drill down to the point that you could ascribe a dollar amount impact on premiums as the result of PBL passage, it goes so far as to say �As demonstrated by the statistics found in this exercise, it can be said that primary enforcement of seat belt laws plays a part in lowering insurance costs. These lower costs in turn result in lower insurance rate increases and even rate decreases.� Hope you find this report of some use.

New CDC Study Finds 5.5 Percent Increase in Injury Mortality from 1999 to 2004

New CDC Study Finds 5.5 Percent Increase in Injury Mortality from 1999 to 2004
Increases in deaths among 20�to�29 and 45�to�54 year olds contribute to first overall increase in years
Injury death rates nationally rose more than 5 percent after a two�decade period of decline, according to a study released by the Centers for Disease Control and Prevention in today$B!l(Js Morbidity and Mortality Weekly Report. The report indicates the largest increases were seen in the 20�29 and 45�54 year age groups.

The total injury mortality rate includes deaths from unintentional injury, suicides, homicides, and injuries of undetermined intent. If a death could not be definitively attributed to unintentional injury or suicide, it is considered to be of undetermined intent. Homicide rates remained stable throughout the 1999�2004 period, with unintentional poisonings accounting for more than half of the total increase in injury deaths.

$B!H(JWe$B!l(Jre very concerned anytime we see an increase in premature deaths,$B!H(J said(J Ileana Arias, Ph.D., director of CDC$B!l(Js National Center for Injury Prevention and Control. $B!H(JWe don$B!l(Jt know if this is an indication of a trend, but it is something that needs to be further examined.$B!H(J

The 45� to 54�year�old age group experienced the largest increase in injury mortality rates. This group had a 25 percent increase, for an additional 8,000 deaths in 2004. In comparison, the 20�29�year age group had an 8 percent increase in total injury death rates. Unintentional poisonings accounted for more than 50 percent of the increase in each group.

Shared risk factors could contribute to the increase in multiple injury categories and age groups, Arias said. For example, the recent increase in prescription drug abuse during the same time period in these age groups could have contributed to an increase in mortality due to suicide, homicide, unintentional poisoning, and other types of unintentional injury. Prevention programs that focus on such shared risk factors could help reduce the number of injury�related deaths.

$B!H(JThe increase in prescription drug overdoses among the middle�aged is something that the CDC has noted before,$B!H(J said Len Paulozzi, M.D., a medical epidemiologist at the Injury Center. $B!H(JWe need to explore the increases in other types of injury for which drug abuse is a risk factor in the same age groups.$B!H(J

For this study, CDC analyzed mortality data on resident deaths occurring in the United States, as compiled from death certificates by the National Vital Statistics System.

For more information about unintentional poisoning prevention, please go to www.cdc.gov/ncipc/factsheets/poisoning.htm.

For more information about suicide prevention, please go to www.cdc.gov/ncipc/dvp/Suicide/default.htm.