Black trauma patients over the age of 65 are 20 percent less likely to die than white seniors, according to a report in JAMA Surgery.
The authors contend that perhaps it is because there is a health care disparity in young minority patients but seniors have more government health care and the health care disparity disappears. Study leader Adil Haider, M.D., M.P.H., an associate professor of surgery at the Johns Hopkins University School of Medicine, doesn't know what to make of it. Arguments for why younger minorities die are claimed to be bias so is it bias against old white people also?
It's cause for speculation, including that black patients have worse expected outcomes from diseases and trauma throughout life, creating a "healthy survivor bias" as they age. In other words, survival of the fittest. So perhaps racial disparities were never racism against younger patients either. Most assume that in an emergency situation, all patients would be treated the same, so outcomes wouldn't vary by race, but that has not been the case, leaving people to scramble for rationalizations then, much like they do about these new results.
"There are well-documented disparities in access to health care for younger black patients, so it is possible that black patients who make it to age 65 have potentially reached that age stronger and healthier than their white counterparts of a similar age," says Johns Hopkins surgical resident Caitlin W. Hicks, M.D., M.S., a member of the research team.
The Johns Hopkins team analyzed in-hospital death rates covering nearly 1.1 million trauma patients in the Nationwide Inpatient Sample for the period between Jan. 1, 2003, and Dec. 30, 2010. Roughly half of the group was between the ages of 16 and 64. In the younger group, racial disparities in survival after trauma conformed to what most other studies have found, namely that black patients were 20 percent more likely to die than white patients. Over the age of 65, the pattern was reversed, with white patients 20 percent more likely to die than black patients. The group used three different statistical models controlling for other illnesses the older patients may have when they are admitted after trauma. All three drew the same conclusions.
The older and younger groups were different in other ways as well, Haider says. The vast majority of patients 65 and older (99.4 percent) had insurance, many of them through Medicare. Also, the vast majority of patients in the older group suffered blunt trauma — car accidents and falls, primarily — as opposed to many more cases of penetrating trauma — gunshot or stab wounds — in the younger age group.
At the outset of the research, Haider, who directs the Center for Surgical Trials and Outcomes Research at Johns Hopkins, says he thought that given the high percentage of insured patients 65 and older, black and white patients would either have similar outcomes, or black patients would continue to have worse outcomes.
"These findings surprised us," he says.
Haider says his team plans to see whether the type of hospital where patients are treated — be it a hospital that treats mostly whites or mostly minorities — has an impact on trauma outcomes for patients 65 and older. Previous research by Haider and his team found that nearly 80 percent of trauma centers in the United States that serve predominantly minority patients have higher-than-expected death rates.
The group has also reported that trauma patients of all races are 40 percent less likely to die — regardless of the severity of their injuries — if they are treated at hospitals with lower-than-expected mortality rates, the vast majority of which serve predominantly white patients.