Race and ethnicity associated with discharge to advanced care facilities after ocular injuries from firearms

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Disparities in race and ethnicity have been uncovered in a study of discharge dispositions after admission for ocular injuries associated with firearms,¹ according to first author Elise Mike, MD, PhD, from Johns Hopkins Wilmer Eye Institute, Baltimore.

The investigators pointed out that ocular trauma is a leading cause of monocular blindness in the US and is the second most common reason for eye-related hospitalizations. The startling statistic is that an estimated 44% to 58% of gun trauma survivors sustain permanent vision loss.^2,3

The researchers undertook a retrospective analysis of the National Trauma Data Bank from 2008 through 2014 to determine the factors associated with discharge to an advanced care facility after admission for firearm-associated ocular injury in the US. The participants included patients admitted with ocular injuries to over 900 facilities.

The data analysis showed that 3.7% of 235,254 firearms injuries (n=8,715) involved the eyes. The breakdown of those patients showed that the vast majority were male (7,469, 85.7%) and 46.6% were white (n=4,065) followed by 35.0% who were Black (n=3,050). The patients were a mean age of 33.8 years.

The insurance coverage was government insurance in 31.5%, self-paid insurance in 29.4%, and commercial insurance plans in 22.8%.

Following treatment, the patients frequently were discharged to home (48.8%) and advanced care facilities (20.5%).

The authors found that the following factors were associated with the highest odds of discharge to an advanced are facility: hospital stays of 6 days or longer (odds ratio [OR], 3.05; 95% confidence interval [CI], 2.56-3.63; p < 0.001), age 65 years or older (OR, 2.94; 95% CI, 1.94-4.48; p < 0.001), associated traumatic brain injury (OR, 2.32; 95% CI, 1.94-2.78; p <0 .001), severe traumatic brain injury (OR, 2.10; 95% CI, 1.79-2.46; p <0 .001), and a very severe Injury Severity Score (OR, 2.22; 95% CI, 1.88-2.62; p< 0.001).

The least associated factor of being discharged to an advanced care facility was orbital injury (OR, 0.83; 95% CI, 0.71-0.96; p =0 .01).

“Interestingly, the association with race and ethnicity (OR, 2.00; 95% CI, 1.71-2.33; o < 0.001) superseded Medicare insurance coverage (OR, 1.64; 95% CI, 1.16-2.30; p = 0.01). White race (OR, 2.00; 95% CI, 1.71-2.33; p < 0.001) was associated with higher odds than Medicare insurance (OR, 1.64; 95% CI, 1.16-2.31; p = 0.01),” Mike and colleagues commented.

The investigators commented on their findings, “This retrospective study revealed that after admission with ocular injuries associated with firearms, white, older, Medicare-insured, and more severely injured patients were more likely to be discharged to advanced care facilities. Sight-threatening ocular injuries associated with firearms had minimal influence on postadmission discharge dispositions. Black and Hispanic patients were disproportionately discharaged home, even after factoring in their injury severity and insurance status. Additional research would appear to be needed to confirm our findings and uncover reasons for these disparities.”

References:

1. Mike EV, Brandsdorfer A, Parsikia A, et al. Disparities associated with discharge patterns in firearm-associated ocular trauma. JAMA Ophthalmol. Published online May 11, 2023. doi:10.1001/jamaophthalmol.2023.1467

2. Kuhn F, Morris R, Witherspoon CD, Mann L. Epidemiology of blinding trauma in the United States Eye Injury Registry. Ophthalmic Epidemiol. 2006;13:209-216. doi:10.1080/09286580600665886PubMedGoogle ScholarCrossref

3. Chopra N, Gervasio KA, Kalosza B, Wu AY. Gun trauma and ophthalmic outcomes. Eye (Lond). 2018;32:687-692. doi:10.1038/eye.2017.249