As the U.S. continues to watch Congress thrash out a plan to try to cover those without health insurance, a new study shows that people admitted to the hospital for trauma are almost twice as likely to die from their injuries if they are uninsured.

A co-author of the study said she and her colleagues weren't surprised at the disparity they found, but they were surprised by how large it turned out to be. Our hope is that people recognize that the results from this study are to be taken seriously, Dr. Heather Rosen of Harvard Medical School in Boston told Reuters Health via E-mail. Being uninsured is a major detriment to one's health, which has been shown in multiple studies addressing hospital admission, treatment, screening, outcomes, and aftercare.

Adults with no health insurance are at 25 percent greater risk of dying from any cause in a given time period than are their insured peers, Rosen and her colleagues note in their report in the Archives of Surgery. Even though the Emergency Medical Treatment and Active Labor Act-also known as the anti-dumping law-mandates that no hospital or ambulance service receiving federal funds turn away patients based on their ability to pay, Rosen and her team still suspected that mortality would still be higher after traumatic injury for uninsured patients.

They analyzed data for 2002 through 2006 on patients admitted to more than 900 trauma centers nationwide, looking at a subset of more than 687,000 patients 18 and older for whom complete information was available on injury severity and insurance status.

After the researchers accounted for the type and severity of patients' injuries, their age and other relevant factors, they found an 80 percent increased risk of death for uninsured patients compared to those with commercial insurance.

Given that younger patients might be healthier and thus more likely to survive injuries, Rosen and her team looked separately at 18 to 30 year olds, and found the excess risk was even greater; these patients were 89 percent more likely to die if they had no insurance. (Rosen said specific numbers of deaths in each grouping were not available.)

When the researchers analyzed patients with head injuries, they found the risk of death from the injury was still higher for those without insurance.

There are likely many factors involved, said Rosen, who worked on the study with surgeon Dr. Atul Gawande, whose reporting on health care costs for The New Yorker gained President Barack Obama's attention this summer.

Uninsured patients may seek care later, they may in fact receive different care in the hospital (which has been shown to be true by multiple other studies), they may have a delay in definitive treatment, and they may have worse accidents/injuries - even though we controlled for injury severity, this may still be possible, she wrote. Also institutions that treat uninsured patients may have fewer resources and less advanced technology.

In a study published last month in the Journal of Pediatric Surgery, Rosen said, she and her colleagues found survival was also worse for uninsured children after traumatic injury.

Our hope is that when universal health care coverage becomes a reality, this disparity will ultimately grow smaller, Rosen said. But we will have to study this again after health care reform is in place to determine if this indeed happens.

SOURCE: Archives of Surgery, November 2009.

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