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Objective <p>To evaluate the association of insurance status and race/ethnicity with in-hospital mortality among pediatric trauma patients.</p> Methods <p>We conducted a retrospective cohort study using the National Trauma Data Bank (2007–2019, excluding 2018). Patients younger than 17 years with an Injury Severity Score &gt; 9 were included. Multivariable logistic regression was used to assess the independent and combined associations of race/ethnicity and insurance status with in-hospital mortality, adjusting for age, sex, injury severity, Glasgow Coma Scale, and mechanism of injury.</p> Results <p>A total of 148,019 pediatric patients were included (66% male; median age 11 years [IQR 5–15]). Non-Hispanic White children comprised 60% of the cohort, followed by Hispanic (15%) and Non-Hispanic Black (15%). Private (38%) and Medicaid (32%) were the most common insurance types; 7.6% were self-pay. Overall mortality was 4.4%, highest among Non-Hispanic Black children (6.6%) and self-pay patients (7.5%). In adjusted analyses, self-pay status was associated with increased mortality compared with Medicaid (OR 1.23, 95% CI 1.12–-0.36), as was Non-Hispanic Black race (OR 1.15, 95% CI 1.06–1.24). Firearm-related injury was strongly associated with mortality (OR 4.18, 95% CI 3.59–4.86). No significant interaction was observed between race/ethnicity and insurance status.</p> Conclusions <p>Insurance status is an independent predictor of mortality in pediatric trauma, with self-pay patients at highest risk. Racial disparities were attenuated after adjustment, and the effect of insurance was consistent across racial and ethnic groups.</p>

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Impact of Race, Ethnicity, and Insurance Type on In-hospital Mortality in Children with Traumatic Injury

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月12日

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  • Tyler Hughes,
  • Daniela Tenorio,
  • Sarim Rizvi,
  • Karthik Rajasekaran,
  • Andrew Meyer,
  • Alvaro Moreira

摘要

Objective

To evaluate the association of insurance status and race/ethnicity with in-hospital mortality among pediatric trauma patients.

Methods

We conducted a retrospective cohort study using the National Trauma Data Bank (2007–2019, excluding 2018). Patients younger than 17 years with an Injury Severity Score > 9 were included. Multivariable logistic regression was used to assess the independent and combined associations of race/ethnicity and insurance status with in-hospital mortality, adjusting for age, sex, injury severity, Glasgow Coma Scale, and mechanism of injury.

Results

A total of 148,019 pediatric patients were included (66% male; median age 11 years [IQR 5–15]). Non-Hispanic White children comprised 60% of the cohort, followed by Hispanic (15%) and Non-Hispanic Black (15%). Private (38%) and Medicaid (32%) were the most common insurance types; 7.6% were self-pay. Overall mortality was 4.4%, highest among Non-Hispanic Black children (6.6%) and self-pay patients (7.5%). In adjusted analyses, self-pay status was associated with increased mortality compared with Medicaid (OR 1.23, 95% CI 1.12–-0.36), as was Non-Hispanic Black race (OR 1.15, 95% CI 1.06–1.24). Firearm-related injury was strongly associated with mortality (OR 4.18, 95% CI 3.59–4.86). No significant interaction was observed between race/ethnicity and insurance status.

Conclusions

Insurance status is an independent predictor of mortality in pediatric trauma, with self-pay patients at highest risk. Racial disparities were attenuated after adjustment, and the effect of insurance was consistent across racial and ethnic groups.