Borders within US trauma care: Disparities in mortality and resource utilization among patients with precarious legal status.

Abstract

Trauma patients with precarious legal status face health care disparities, yet national outcome data remain limited. We evaluated mortality and resource utilization differences between precarious legal status and US resident trauma patients. This retrospective cohort study analyzed 2021-2023 American College of Surgeons Trauma Quality Improvement Program data, comparing adult precarious legal status and US resident patients. The primary outcome was in-hospital mortality; secondary outcomes included hospital length of stay, intensive care unit length of stay, and ventilator days. One-to-one propensity score matching balanced groups (n = 2,615 each) on age, sex, injury severity score, trauma type, and traumatic brain injury. Multivariable logistic regression adjusted for demographic and clinical covariates. After matching, precarious legal status patients were predominantly Hispanic/Latino (83.9% vs 23.0%; P < .001), with falls being the most common mechanism of injury (70.0% vs 27.4%; P < .001). Precarious legal status patients were more often self-pay (26.8% vs 17.5%; P < .001) and less often used private insurance (7.0% vs 43.4%; P < .001). Precarious legal status patients experienced higher mortality (2.6% vs 1.6%; P = .013), longer hospital length of stay (9.6 vs 6.4 days; P < .001), longer intensive care unit length of stay (1.7 vs 1.4 days; P = .016), and more ventilator days (1.0 vs 0.6; P = .006). Precarious legal status was associated with higher mortality, after adjusting for other covariates (odds ratio, 2.03; 95% confidence interval, 1.20-3.46; P = .009). Precarious legal status was independently associated with increased mortality and resource utilization in trauma patients, highlighting the need for enhanced discharge planning, social work support, and strategies to improve postdischarge follow-up in this vulnerable population.