An analysis of more than 1 million trauma patients' records revealed a surprising result for researchers – black patients aged 65 and older had 20 percent better odds of survival than their white counterparts.

“We have long found it vexing that minority patients consistently do worse, even in treatment for trauma that seems to leave little room for bias,” study leader Adil Haider, M.D., an associate professor of surgery at the Johns Hopkins University School of Medicine, said. “And although we still see the disparity in younger black patients, we were surprised to find in this study that older black trauma patients were more likely to survive their injuries.”

Haider speculates that one reason is that all patients over 65 have better access to healthcare because of Medicare eligibility, providing access to care that may “level the playing field.” Another possibility is that black patients have worse expected outcomes from diseases and trauma throughout life, creating a “healthy survivor bias” as they age.

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.

The research was published in JAMA Surgery.

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