Association Between Insurance Status and Hospital Length of Stay Following Trauma.


Journal Article

Previous research has demonstrated that nonclinical factors are associated with differences in clinical care, with uninsured patients receiving decreased resource use. Studies on trauma populations have also shown unclear relationships between insurance status and hospital length of stay (LOS), a commonly used metric for evaluating quality of care. The objective of this study is to define the relationship between insurance status and LOS after trauma using the largest available national trauma dataset and controlling for significant confounders. Data from 2007 to 2010 National Trauma Data Bank were used to compare differences in LOS among three insurance groups: privately insured, publically insured, and uninsured trauma patients. Multivariable regression models adjusted for potential confounding due to baseline differences in injury severity and demographic and clinical factors. A total of 884,493 patients met the inclusion criteria. After adjusting for the influence of covariates, uninsured patients had significantly shorter hospital stays (0.3 days) relative to privately insured patients. Publicly insured patients had longer risk-adjusted LOS (0.9 days). Stratified differences in discharge disposition and injury severity significantly altered the relationship between insurance status and LOS. In conclusion, this study elucidates the association between insurance status and hospital LOS, demonstrating that a patient's ability to pay could alter LOS in acute trauma patients. Additional research is needed to examine causes and outcomes from these differences to increase efficiency in the health care system, decrease costs, and shrink disparities in health outcomes.

Full Text

Cited Authors

  • Englum, BR; Hui, X; Zogg, CK; Chaudhary, MA; Villegas, C; Bolorunduro, OB; Stevens, KA; Haut, ER; Cornwell, EE; Efron, DT; Haider, AH

Published Date

  • March 2016

Published In

Volume / Issue

  • 82 / 3

Start / End Page

  • 281 - 288

PubMed ID

  • 27099067

Pubmed Central ID

  • 27099067

Electronic International Standard Serial Number (EISSN)

  • 1555-9823

International Standard Serial Number (ISSN)

  • 0003-1348


  • eng