TY - JOUR
T1 - The coronavirus disease 2019 (COVID-19) stay-at-home order's unequal effects on trauma volume by insurance status in Southern California
AU - Yeates, Eric O.
AU - Juillard, Catherine
AU - Grigorian, Areg
AU - Schellenberg, Morgan
AU - Owattanapanich, Natthida
AU - Barmparas, Galinos
AU - Margulies, Daniel
AU - Garber, Kent
AU - Cryer, Henry
AU - Tillou, Areti
AU - Burruss, Sigrid
AU - Penaloza-Villalobos, Liz
AU - Lin, Ann
AU - Figueras, Ryan Arthur
AU - Brenner, Megan
AU - Firek, Christopher
AU - Costantini, Todd
AU - Santorelli, Jarrett
AU - Curry, Terry
AU - Wintz, Diane
AU - Biffl, Walter L.
AU - Schaffer, Kathryn B.
AU - Duncan, Thomas K.
AU - Barbaro, Casey
AU - Diaz, Graal
AU - Johnson, Arianne
AU - Chinn, Justine
AU - Naaseh, Ariana
AU - Leung, Amanda
AU - Grabar, Christina
AU - Yeates, Todd O.
AU - Nahmias, Jeffry
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/9
Y1 - 2021/9
N2 - Background: The rapid spread of coronavirus disease 2019 in the United States led to a variety of mandates intended to decrease population movement and “flatten the curve.” However, there is evidence some are not able to stay-at-home due to certain disadvantages, thus remaining exposed to both coronavirus disease 2019 and trauma. We therefore sought to identify any unequal effects of the California stay-at-home orders between races and insurance statuses in a multicenter study utilizing trauma volume data. Methods: A posthoc multicenter retrospective analysis of trauma patients presenting to 11 centers in Southern California between the dates of January 1, 2020, and June 30, 2020, and January 1, 2019, and June 30, 2019, was performed. The number of trauma patients of each race/insurance status was tabulated per day. We then calculated the changes in trauma volume related to stay-at-home orders for each race/insurance status and compared the magnitude of these changes using statistical resampling. Results: Compared to baseline, there was a 40.1% drop in total trauma volume, which occurred 20 days after stay-at-home orders. During stay-at-home orders, the average daily trauma volume of patients with Medicaid increased by 13.7 ± 5.3%, whereas the volume of those with Medicare, private insurance, and no insurance decreased. The average daily trauma volume decreased for White, Black, Asian, and Latino patients with the volume of Black and Latino patients dropping to a similar degree compared to White patients. Conclusion: This retrospective multicenter study demonstrated that patients with Medicaid had a paradoxical increase in trauma volume during stay-at-home orders, suggesting that the most impoverished groups remain disproportionately exposed to trauma during a pandemic, further exacerbating existing health disparities.
AB - Background: The rapid spread of coronavirus disease 2019 in the United States led to a variety of mandates intended to decrease population movement and “flatten the curve.” However, there is evidence some are not able to stay-at-home due to certain disadvantages, thus remaining exposed to both coronavirus disease 2019 and trauma. We therefore sought to identify any unequal effects of the California stay-at-home orders between races and insurance statuses in a multicenter study utilizing trauma volume data. Methods: A posthoc multicenter retrospective analysis of trauma patients presenting to 11 centers in Southern California between the dates of January 1, 2020, and June 30, 2020, and January 1, 2019, and June 30, 2019, was performed. The number of trauma patients of each race/insurance status was tabulated per day. We then calculated the changes in trauma volume related to stay-at-home orders for each race/insurance status and compared the magnitude of these changes using statistical resampling. Results: Compared to baseline, there was a 40.1% drop in total trauma volume, which occurred 20 days after stay-at-home orders. During stay-at-home orders, the average daily trauma volume of patients with Medicaid increased by 13.7 ± 5.3%, whereas the volume of those with Medicare, private insurance, and no insurance decreased. The average daily trauma volume decreased for White, Black, Asian, and Latino patients with the volume of Black and Latino patients dropping to a similar degree compared to White patients. Conclusion: This retrospective multicenter study demonstrated that patients with Medicaid had a paradoxical increase in trauma volume during stay-at-home orders, suggesting that the most impoverished groups remain disproportionately exposed to trauma during a pandemic, further exacerbating existing health disparities.
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U2 - 10.1016/j.surg.2021.02.060
DO - 10.1016/j.surg.2021.02.060
M3 - Article
C2 - 33849732
AN - SCOPUS:85103924189
SN - 0039-6060
VL - 170
SP - 962
EP - 968
JO - Surgery (United States)
JF - Surgery (United States)
IS - 3
ER -