Racial Disparities at Mixed-Race and Minority Hospitals: Treatment of African American Males with High-Grade Splenic Injuries

Christopher J. Tignanelli, Bradly Watarai, Yunhua Fan, Ashley Petersen, Mark Hemmila, Lena Napolitano, Stephanie Jarosek, Anthony Charles

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


INTRODUCTION: Racial and socioeconomic disparities in health access and outcomes for many conditions are well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American (AA) versus white males with high-grade splenic injuries.

METHODS: Data from the National Trauma Data Bank was utilized from 2007 to 2015. A total of 24 855 AA or white males with high-grade splenic injuries were included. Multilevel mixed effects regression analysis was used to evaluate disparities in outcomes and resource allocation.

RESULTS: Mortality was significantly higher for AA males at mixed-race (odds ratio [OR] 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2; P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08).

DISCUSSION: While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.

Original languageEnglish (US)
Pages (from-to)441-449
Number of pages9
JournalAmerican Surgeon
Issue number5
StatePublished - May 2020

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Mark R. Hemmila receives support from Blue Cross Blue Shield of Michigan and Blue Care Network (a nonprofit mutual company) for conduct of The Michigan Trauma Quality Improvement Program with a Collaborative Quality Initiatives grant. This research was funded by a grant awarded to CJT from the University of Minnesota’s Center for Healthy

Publisher Copyright:
© 2020 Southeastern Surgical Congress. All rights reserved.


  • Adolescent
  • Adult
  • African Americans
  • Aged
  • European Continental Ancestry Group
  • Healthcare Disparities/statistics & numerical data
  • Hospitals/classification
  • Humans
  • Injury Severity Score
  • Male
  • Middle Aged
  • Minority Groups
  • Spleen/injuries
  • United States
  • Young Adult

PubMed: MeSH publication types

  • Journal Article
  • Comparative Study


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