Insurance, Race and Region-Related Disparities in Mortality from Vascular Injury Following Abdominal Gunshot Wounds
Khanjan H. Nagarsheth, MD, MBA, Viktor Dombrovskiy, MD, Saum Rahimi, MD.
Rutgers University - Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
OBJECTIVES: Vascular injuries (VI) occur in up to 25% of patients with abdominal gunshot wounds (GSW) and portends an increased risk of mortality. To determine if disparities exist in this patient population, we categorized patients by insurance status, race and geographic location.
METHODS: The National Inpatient Sample of the Healthcare Cost and Utilization Project was queried from 2003-2013 to identify a principle diagnosis of abdominal GSW with vascular injury based on ICD-9-CM code. These groups were then stratified according to age, race, gender and insurance status. Outcomes were then analyzed.
RESULTS: There were 7,421 abdominal VI related to GSW, identified during this time period. The mean age of this population was 29.4±13.3 years and 89.3% were male. Minority race was more frequently associated with abdominal VI compared to Caucasians (African American odds ratio (OR) 1.75, 95% confidence interval (CI) 1.63-1.87, Hispanic OR 1.72, CI 1.58-1.86, p<0.0001). The southern (S) states had the highest proportion of abdominal VI (40.3% v. 18.2% Northeast (NE), 18.7% Midwest (MW) and 21.8% West (W), p<0.0001).
Patients undergoing a vascular bypass for abdominal VI had a significantly higher mortality (43.0% v. 29.6%, p<0.0001) with and increased odds ratio for mortality (OR 1.79, CI, 1.36-2.34, p<0.0001). Post-operative complications were most prevalent in African Americans, compared to Caucasians (46.9% v. 16.0%, p<0.0001). Mortality was also higher in African Americans compared to Caucasians (46.2% v. 14.0%, p=0.0339), though this did not reach statistical significance in regression analysis (OR 1.14, CI 0.98-1.32, p=0.09). Despite a higher frequency of abdominal VI in the S, there was a significantly lower mortality compared to the NE (28.0% v. 35.8%, p<0.0001) (OR 0.69, CI 0.61-0.80, <0.0001) . Lack of insurance also had an increased odds ratio of mortality compared to those with insurance (OR 2.47, CI 2.22-2.75, p<0.0001).
CONCLUSIONS: These results demonstrate that uninsured patients and those in the Northeast, have a significantly higher risk of mortality from vascular injury after abdominal gunshot wound compared to other insurance-type groups or those in the South. Additional research is needed to understand these results and potentially reduce mortality in these patients.
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