The coronavirus disease 2019 (COVID-19) stay-at-home order's unequal effects on trauma volume by insurance status in Southern California

Eric O. Yeates, Catherine Juillard, Areg Grigorian, Morgan Schellenberg, Natthida Owattanapanich, Galinos Barmparas, Daniel Margulies, Kent Garber, Henry Cryer, Areti Tillou, Sigrid Burruss, Liz Penaloza-Villalobos, Ann Lin, Ryan Arthur Figueras, Megan Brenner, Christopher Firek, Todd Costantini, Jarrett Santorelli, Terry Curry, Diane WintzWalter L. Biffl, Kathryn B. Schaffer, Thomas K. Duncan, Casey Barbaro, Graal Diaz, Arianne Johnson, Justine Chinn, Ariana Naaseh, Amanda Leung, Christina Grabar, Todd O. Yeates, Jeffry Nahmias

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)962-968
Number of pages7
JournalSurgery (United States)
Volume170
Issue number3
DOIs
StatePublished - Sep 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 Elsevier Inc.

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