Each year trauma, which includes injuries, burns, and falls, accounts for 41 million emergency department visits and 2.3 million hospital admissions nationwide. If you landed in a hospital having suffered a blow to the head or a severe burn, would you live? That depends on your race and age, suggests a new study, which arrived at some surprising (and paradoxical) results. “Although younger white patients have better outcomes after trauma than younger black patients, older black patients have better outcomes than older white patients,” the authors wrote in the study appearing online in JAMA Surgery.

May is National Trauma Awareness Month and for good reason: Trauma is the number one killer among those between the ages of 1 and 44 — 47 percent of all deaths in this age range are caused by a fall, injury, or burn — and the third leading cause of death across all age groups. Mortality aside, physical traumas may also cause ongoing disability and lost time at work, all the while taxing an already overburdened health care budget.

For the current study, a team of researchers led by Dr. Caitlin W. Hicks of the Johns Hopkins School of Medicine chose to investigate whether racial disparities in survival rates after traumatic injury existed. Do black patients die more frequently than white patients? Using an approach that allowed for a comparison of patients with similar existing conditions and injury severity, the researchers examined in-hospital mortality after trauma for black and white patients within two separate age ranges: those between the ages of 16 and 64 years and those older than 65. The study included more than one million patients (502,167 patients were age 16 to 64 years and 571,028 patients were 65 years and older) and included those with blunt or penetrating injuries.

What did the researchers find?  Over an eight-year period, younger white patients were more likely to survive a trauma than younger black patients, but older black patients fared better than similarly injured older white patients. The authors noted that similar findings have been seen among non-trauma patients. “One commonly posited explanation for these age-dependent racial disparities is the availability of Medicare, and, consequently, better access to pre-stressor care, in the older population,” wrote the authors. Similarly, the Veterans Affairs health care system also has reported outcomes that are contrary to those of the general population; in the VA system, where black and white members have equal insurance coverage, no racial disparities in survival exist after surgical procedures.

 

Source: Hicks CW, Hashmi ZG, Velopulos C, et al. Association Between Race and Age in Survival After Trauma. JAMA Surgery. 2014.