Race Impacts Outcomes of Patients With Firearm Injuries

Abstract

Background To study the relationship between race and outcomes of patients with firearm injuries hospitalized in the United States. Methods The 2016 National Inpatient Sample was used. Patients were included if they had a principal diagnosis of firearm injury. Exclusion criteria were age <16 years and elective admissions. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity (traumatic shock, prolonged mechanical ventilation, acute respiratory distress syndrome [ADRS], and ventilator-associated pneumonia [VAP]), and resource utilization (length of stay and total hospitalization charges and costs). Results The sample included 31 335 patients; 52% were Black and 29% were Caucasian. The mean age was 32 years and 88% were male. Black patients had lower odds of mortality (adjusted odds ratio (aOR): 0.41 (95% CI: 0.32-0.53), P < .01). However, compared with Caucasians, Blacks had higher mean total hospitalization charges (adjusted mean difference (aMD) : $14 052 (CI: $1469-$26 635), P = .03) and costs (aMD: $3248 (CI: $654-$5842), P = .01) despite similar mean length of stay (aMD: 0.70 (CI: −0.05-1.45), P = .07). Both racial groups had similar rates of traumatic shock (aOR: 0.91 (0.72-1.15), P = .44), prolonged mechanical ventilation (aOR: 0.82 (0.63-1.09), P = .17), ARDS (aOR: 1.18 (0.45-3.07), P = .74) and VAP (aOR: 1.27 (0.47-3.41), P = .63). Discussion Black patients with firearm injuries had a lower adjusted odds of in-hospital mortality compared with other races. However, despite having a similar hospital length of stay and in-hospital morbidity, -Black patients had higher total hospitalization costs and charges.