Gunshot Victims without Health Insurance Have Higher Mortality
People who are victims of a gunshot injury and who do not have health insurance are more than twice as likely to die than gunshot victims who have health insurance. The higher mortality among uninsured gunshot victims was a surprise to the authors of the study, which was published in the Journal of the American College of Surgeons.
The US Census figures from 2008 show that 46.3 million people have no health insurance. A lack of coverage has been linked with 45,000 deaths per year in the United States, an increased risk of death among hospitalized children, and millions of people not getting important health screenings, dental care, prescriptions, and other important health and medical care. Until now, no one had explored a relationship between having health insurance and race on mortality following a gunshot injury.
A research team from the University of California, San Francisco, East Bay Alameda County Medical Center examined the records from their facility of adult (ages 18 to 64) gunshot injury victims and their insurance status from January 1998 to December 2007. They considered patients who stayed less than 31 days and only those who were alive on arrival to the trauma center.
Of the 2,164 gunshot cases they reviewed, nearly 75 percent (1,620) of the victims did not have health insurance, 25 percent (544) of them did, and less than 1 percent (16) had Medicare or Medicaid. The breakdown by race was almost 75 percent African-American (1,586), less than 25 percent Hispanic (444), and six percent Caucasian (134). Ninety-two percent were male, and the average age was 28 years.
All the gunshot victims were equally likely to have undergone radiographic examination or surgery for their injuries, regardless of their insurance status. However, the mortality rate for patients who did not have health insurance was 9 percent compared with 6 percent among those who had insurance. The investigators made adjustments for age, gender, the severity of the injury, and race, and the result was that the risk of dying from a gunshot injury was 2.2 times greater for patients who did not have health insurance versus those who did have coverage.
The results of this study indicate yet one more consequence of not having health insurance, although the reason for the disparity among gunshot victims is not clear. Kristopher Dozier, MD, one of the study’s authors, noted that he and his team “were surprised to see pronounced disparities in outcome in a relatively young patient population.” They believe their findings “underscore the need for improvement in social determinants of health, like insurance coverage, among people affected by violent trauma.”
Dozier KC et al. Journal of the American College of Surgeons 2010 Mar; 210(3): 280-85