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  • Discharge Disparities After Ocular Injury From Firearms

    By Lynda Seminara
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, June 2023

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    Building on evidence of racial, ethnic, and insurance-related disparities in trauma care, Mike et al. were eager to learn whether such inequity extends to the discharge practices for patients who sustain a firearm-related ocular injury. Their review of more than 8,700 cases, representing roughly 900 U.S. care centers, showed substantial differences in discharge patterns. Patients who were older, Medicare-insured, and White were more likely than others, including Blacks and Hispanics, to be released to an advanced care facility (ACF).

    The study was a retrospective anal­ysis of the U.S. National Trauma Data Bank for the period 2008-2014. The data were scanned to identify patients who were hospitalized for a firearm-associated ocular injury, determined from ICD-9-CM diagnostic and E-codes. The collected data included demographics, injury type and sever­ity, and insurance status. Statistical analyses were conducted through 2021. The primary outcome measure was the likelihood of discharge to an ACF.

    Altogether, 8,715 relevant patients were identified. Most (85.7%) were male, 35% were African American, and approximately 47% were White. The mean age was 33.8 years. Payments for the trauma care were received from government insurance plans (31.5%), patients themselves (29.4%), or commercial health plans (22.8%). The most common discharge dispo­sitions were home (48.8%) and ACF (20.5%). According to multivariate analysis, factors linked to the highest odds of ACF placement were hospital stay ≥6 days (OR, 3.05; p < .001), age ≥65 years (OR, 2.94; p < .001), associ­ated traumatic brain injury (OR, 2.32; p < .001), severe traumatic brain injury (OR, 2.10; p < .001), and very severe injury (OR, 2.22; p < .001). White patients had the highest odds of release to an ACF, regardless of insurance status (OR range, 2.17-2.80; p < .001). Black patients on Medicare (OR, 3.31; p < .001) or who self-paid (OR, 2.05; p < .001) were more likely than others to be discharged home. The racial and ethnic disparities in discharge patterns were apparent regardless of age, injury severity, or geographic location.

    The authors noted that more research is needed to confirm or refute the findings and to explore reasons for the disparities. (Also see related commentary by Albert Y. Wu, MD, PhD, and Anne Xuan-Lan Nguyen, in the same issue.)

    The original article can be found here.